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This guide covers both architectures, the security work that belongs around them, HTTPS, validation, backups, and upgrades. Version requirements change, so match every package and image to the exact OpenEMR release you select rather than treating one release’s requirements as permanent.
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What an Ubuntu VPS deployment actually contains
OpenEMR is not a single binary that runs by itself. The application needs a PHP-capable web server and a MySQL-compatible database. In a native installation, those roles are supplied by Apache (or another PHP-capable server), PHP, and MySQL or MariaDB. In the official Docker design, containers provide the application and a companion database service.
The boundary between the public internet and the database is important. Your DNS name should point to the web-facing VPS, while the database should be reachable only by the OpenEMR application over a private Docker network or local host connection. Do not publish the database port to the internet.
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The exact OpenEMR release determines PHP, extension, database, and operating-system requirements. The project’s Linux guide for OpenEMR 7.0.4 specifies PHP 8.2 or newer, required PHP extensions and settings, and an Apache LimitRequestFieldSize value of 32768. Those values are release-specific; recheck the guide for the release you intend to install.
Docker or native Linux: choose before provisioning
| Decision area | Official Docker image | Native Apache/PHP/MySQL or MariaDB |
|---|---|---|
| Repeatability | Pinning an image tag or digest reproduces the application stack more consistently. | You control every operating-system package and service configuration, but must record and reproduce them yourself. |
| Initial setup | The documented compose pattern and environment variables reduce manual wiring. | More hands-on work: install PHP and extensions, configure Apache, prepare the database, and set filesystem permissions. |
| TLS | The image documents ports 80 and 443 and can obtain and maintain a Let’s Encrypt certificate when DOMAIN and, optionally, EMAIL are supplied. |
You configure certificates, virtual hosts, and renewal in the host web-server stack. |
| Ongoing maintenance | Maintain the compose file, secrets, persistent volumes, and image updates. | Maintain Ubuntu packages, PHP, Apache, the database, OpenEMR files, and their interactions. |
| Best fit | A new deployment where predictable rebuilds and simpler upgrades matter. | An administrator who needs direct control of Apache, PHP, database settings, or the host filesystem. |
Neither option removes the need for backups, patching, access control, log review, and upgrade rehearsals. Docker changes what you maintain; it does not make the application maintenance-free.
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Prerequisites and design decisions
Pick a supported OpenEMR release
Start with the release documentation, not with an old tutorial. The OpenEMR installation-guides index presents Docker as the modern plug-and-play route while retaining Linux tarball instructions for administrators who need direct web-server control. Read the guide for the exact release, then record its PHP, database, extension, and web-server requirements in your deployment notes.
Prepare the Ubuntu host
- Provision an up-to-date Ubuntu VPS and apply security updates before installing OpenEMR.
- Create a non-root administrative account and use that account for routine administration. Reserve root privileges for the specific system changes that require them.
- Decide whether the VPS will be dedicated to OpenEMR. Keeping unrelated public services off the host reduces the number of components you must patch and investigate.
- Choose where persistent application files, database data, logs, and backups will live. Ensure the storage plan can be expanded without moving a live database blindly.
Plan the hostname and network
Choose the final OpenEMR hostname before requesting a certificate. Create the DNS A record for IPv4 and an AAAA record only when the VPS has working IPv6 configured. Verify that both records resolve to the intended host before enabling certificate automation.
Allow only the services your design needs through the firewall: SSH for administration and the web ports required by the deployment. The Docker image uses port 80 for HTTP and 443 for HTTPS. A native installation may initially need HTTP for certificate issuance, but the finished service should direct users to the HTTPS endpoint. Keep MySQL or MariaDB off the public interface.
Decide how secrets will be handled
Use a protected environment file or a secret-management mechanism for database and OpenEMR credentials. Do not place passwords in a publicly readable compose file, paste them into support tickets, or commit them to source control. Limit read access to the account that operates the stack and include secret rotation in your operational notes.
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Deploying with the official Docker image
1. Obtain the production compose pattern
Use the OpenEMR project’s official production compose example as the starting point. It defines the OpenEMR service and its MySQL or MariaDB companion, persistent storage, and a private application-to-database network. Do not substitute a random community compose file when the official project provides one; small differences in volumes, health checks, or initialization variables can change upgrade behavior.
2. Pin the application and database images
Use a dated image tag or, preferably, the digest shown in the project’s production example. The Docker Hub listing showed the OpenEMR tag 8.4.1-2026-10-14 at the time of the version check on 2026-10-14. Treat that value as a point-in-time example, not as a permanent recommendation: tags and dependencies change, so verify the current tag or digest immediately before deployment and record what you used.
Pin the companion MySQL or MariaDB image as well. An unpinned latest tag can change the database version without a controlled review, making rollback and troubleshooting harder.
3. Set the required environment variables
The official image requires the database host and root password variables for automatic installation. Set them in the protected environment mechanism used by your compose deployment.
MYSQL_HOST: the service name or private hostname by which the OpenEMR container reaches the database.MYSQL_ROOT_PASS: the database root password used during initialization.- Optional database-name, database-user, and database-password variables: use these when you need names or credentials other than the image defaults.
- Optional OpenEMR credential variables: set the initial application credentials according to the release documentation rather than leaving a documented default in place.
DOMAIN: the public hostname when you want the image to configure Let’s Encrypt.EMAIL: an optional contact address for the certificate setup and maintenance flow.
Keep the environment file outside the web root and protect it with restrictive ownership and permissions. Confirm that backups of your deployment metadata do not accidentally expose these values.
4. Start the stack and complete any installer
From the directory containing the production compose file and protected environment file, start the stack with Docker Compose. The selected image may initialize automatically or may present a web installer. Follow the release-specific instructions, then change any initial credentials before inviting users.
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Wait for the database service and application service to become healthy before judging the deployment. A first start can take longer while the database initializes. Inspect container logs for configuration or connection errors instead of repeatedly restarting the stack.
5. Confirm persistent storage
Verify that the compose file maps persistent volumes or host directories for both the database and OpenEMR data. A container that works only while its writable layer exists is not a usable medical-record deployment. Stop and start the stack once during testing and confirm that the application, users, and uploaded documents remain present.
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With DNS pointing to the VPS and ports 80 and 443 reachable, supply DOMAIN and, if desired, EMAIL so the image can perform Let’s Encrypt certificate setup and maintenance. Check the logs for successful issuance, then open the site over HTTPS and inspect the certificate hostname and expiry. Do not test certificate automation against a DNS name that still resolves elsewhere.
7. Run application checks
Log in through the public hostname and test the functions that matter to your deployment:
- Create a non-administrative test account and confirm that permissions behave as intended.
- Upload a test document, retrieve it, and verify that the file remains after a container restart.
- Check scheduled jobs and any task runner described by the selected release.
- Review mail and integration settings without sending real patient information during testing.
- Inspect application and database logs for warnings, failed connections, or permission errors.
Installing OpenEMR natively on Ubuntu
1. Install the release-supported stack
Install the PHP version, extensions, settings, Apache configuration, and MySQL or MariaDB packages listed for your chosen OpenEMR release. For the OpenEMR 7.0.4 Linux guide, the documented PHP baseline is 8.2 or higher. Do not assume that the newest PHP release is automatically compatible; use the version range stated by OpenEMR.
2. Prepare Apache and the database
Configure Apache as the PHP-capable web server and create the database and credentials required by OpenEMR. Bind the database to the local host or a private interface, not to a public address. If the database must be on another private server, restrict the database firewall rule to the OpenEMR host and use encrypted transport according to the database documentation.
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The 7.0.4 Ubuntu example uses /var/www/html as the web-root path. A different release or a deliberate virtual-host layout may use another path; follow the selected guide consistently in Apache, file ownership, and backup scripts.
3. Apply the Apache request-size setting
The OpenEMR 7.0.4 Linux instructions specify LimitRequestFieldSize 32768. Apply that setting in the appropriate Apache configuration location for your release and virtual host, then validate the Apache configuration before reloading it. Carry the value with its release qualification: it is a requirement in that guide, not a universal setting for every future OpenEMR version.
4. Run setup and correct permissions
Place the OpenEMR files in the configured web root, open the site, and complete the installer. Native setup can require certain OpenEMR paths to be writable temporarily. Grant only the access the installer requests, complete initialization, and then return those paths to restrictive ownership and permissions. Leave the web server unable to write arbitrary parts of the operating system.
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For native Apache, create the HTTPS virtual host, install a certificate through your chosen certificate workflow, and test renewal before relying on it. The Docker image’s automatic certificate behavior does not apply to a native installation; certificate issuance and renewal are host-web-server responsibilities.
HTTPS, DNS, and exposure checks
HTTPS is not complete merely because a certificate was once issued. Check the entire path:
- Resolve the A and, if used, AAAA records from an external network.
- Confirm that the hostname in the certificate exactly matches the hostname users enter.
- Verify that port 80 is available for the certificate workflow required by your design and that port 443 serves OpenEMR.
- Confirm that the application redirects or otherwise guides users to the HTTPS endpoint according to the release configuration.
- Ensure no MySQL or MariaDB port appears in the VPS’s public firewall rules or cloud security-group rules.
- Review certificate-renewal logs and perform a controlled renewal test before the first certificate approaches expiry.
If certificate issuance fails, check DNS first, then firewall reachability, then whether another service already owns ports 80 or 443. Correct the underlying conflict instead of repeatedly requesting certificates.
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Backups that can restore the service
A VPS snapshot alone is not a complete OpenEMR backup plan. Protect both the OpenEMR installation files and the database. The OpenEMR installation documentation states: “Be sure to back up your OpenEMR installation and database before upgrading.” Treat that as a minimum rule for every upgrade and configuration change that could alter data.
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- The MySQL or MariaDB database, including a consistent dump or database-native backup.
- OpenEMR application files and any persistent document-upload directories.
- Deployment metadata: the compose file or native Apache/PHP configuration, image tags or digests, and the names of persistent volumes.
- Secret recovery information stored through a protected mechanism. Do not place plaintext passwords in an unsecured backup archive.
How to make the backup useful
- Schedule backups at an interval appropriate to the data you can afford to recreate.
- Encrypt backup archives before sending them off-site.
- Keep more than one recovery point so a corruption or accidental deletion is not copied forever.
- Record the OpenEMR version, database version, and backup timestamp with each set.
- Perform periodic restore tests on an isolated staging VPS. A backup that has never been restored is an assumption, not a verified recovery plan.
During a restore test, confirm that users can log in, documents open, scheduled jobs run, and integrations remain disabled or safely configured until you deliberately enable them.
Upgrade procedure for Docker and native installs
- Read the OpenEMR release notes and the installation guidance for the target version. Check PHP, database, extension, and migration requirements.
- Take a fresh backup of both the installation and database, then create a VPS or volume snapshot when your provider supports it.
- Rehearse the upgrade on staging using a copy of the backup. Record any schema migration time, permission change, or manual post-upgrade step.
- Schedule a maintenance window and communicate that the application may be unavailable while migrations run.
- For Docker, update the pinned OpenEMR and database image references deliberately. Do not silently replace a digest with an unreviewed moving tag.
- For native Linux, update the OpenEMR files and only the host packages supported by the target release. Preserve the Apache, PHP, database, and permission changes that the installer requires.
- Start the upgraded service, watch logs during initialization, and complete any web migration screen.
- Run the post-upgrade checks: login, role permissions, document upload and retrieval, scheduled jobs, mail or integration settings, HTTPS, and backup execution.
- Keep the pre-upgrade backup until the new version has passed your acceptance checks and the retention policy allows its removal.
Troubleshooting by symptom
The application cannot connect to the database
In Docker, verify that MYSQL_HOST matches the database service name on the private network and that MYSQL_ROOT_PASS matches the initialized database credentials. Check both container logs and confirm that the database volume was not replaced accidentally. In a native install, verify the database service status, hostname, port, username, password, and local/private bind address.
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Check the A and AAAA records, wait for the intended DNS records to propagate, and make sure the browser is using the same hostname supplied to the certificate configuration. An incorrect AAAA record can send IPv6 clients to a different machine even when the A record is correct.
Let’s Encrypt cannot issue a certificate
Confirm that the hostname resolves to this VPS from outside your network and that the required HTTP and HTTPS ports reach the intended service. Check for another process occupying port 80 or 443, and inspect the image or Apache logs for the exact challenge failure.
Uploaded documents disappear after a restart
Check that document storage is mapped to a persistent Docker volume or backed-up native directory. A container writable layer or an untracked temporary directory will not survive replacement. Verify persistence with a deliberate stop-and-start test before using the system for real records.
The native installer reports permission errors
Compare ownership and mode settings with the release guide, grant write access only to the paths the installer identifies, and remove that temporary write access after setup. Also check that Apache can traverse the parent directories without granting broad write access.
An upgrade fails or leaves the application inconsistent
Stop making ad-hoc changes and preserve the logs. Confirm the target release’s PHP and database requirements, restore the pre-upgrade backup in staging, and repeat the migration there. If the staging restore succeeds, schedule the production retry with the documented sequence and a fresh rollback point.
Production-readiness checklist
- Ubuntu is updated and administration uses a non-root account.
- SSH and only the required web ports are allowed through the firewall.
- DNS A and AAAA records, if used, point to the correct VPS.
- The database is private and not publicly exposed.
- Docker image tags or digests, or native package versions, are recorded and intentionally pinned.
- Credentials are held in a protected environment file or secret mechanism.
- HTTPS works for the final hostname and renewal has been tested.
- Persistent application files and database storage survive a restart.
- Login, roles, document upload, scheduled jobs, and mail or integration settings have been tested.
- Encrypted off-site backups contain both files and database data.
- A restore test has been completed and the pre-upgrade backup is retained during every upgrade.
Bottom line
Use the official Docker deployment when reproducibility, documented environment variables, and simpler image-based upgrades are your priorities. Use the native Ubuntu installation when you need direct Apache, PHP, database, or filesystem control. In either case, the reliable pattern is the same: harden the VPS, keep the database private, pin versions, enable and verify HTTPS, test persistence, and prove that both the OpenEMR files and database can be restored before you upgrade.
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