NOSH ChartingSystem (New Open Source Health) is a free, open-source web-based electronic health record for outpatient doctors, created by Michael Chen, MD, a family physician in Portland, Oregon. This page is for small-practice owners and IT people who search for the “NOSH charting system” or “NOSH EHR”. There is no NOSH dental plugin and no odontogram: the official repositories describe it as a record system for doctors and patients, and nothing in them relates to dentistry.
The current generation, NOSH 3, was rewritten from scratch as a Progressive Web App with a Vue.js front end and a CouchDB/PouchDB database whose data structures are FHIR-native. It has no numbered releases and its code has not been updated since March 2025, so treat it as a dormant project.
NOSH ChartingSystem at a glance
| Item | Details |
|---|---|
| Latest version | NOSH 3 (no tagged releases); last code update 30 March 2025. NOSH 2 (Laravel) last updated August 2024 |
| Licence | Free and open source, GNU Affero General Public License (AGPL) |
| Platforms | Web: NOSH 3 runs in Docker (Node.js app, CouchDB, Traefik); NOSH 2 on a LAMP server; any modern browser as client |
| Developer | Michael Chen, MD (GitHub: shihjay2) |
| Official website | github.com/shihjay2/nosh3 (project blog: noshemr.wordpress.com) |
| Best for | Developers and tech-savvy solo physicians exploring a FHIR-native, patient-centred EHR design |
What it does
- Works as a provider-centred EHR or as a patient-held personal health record.
- Passwordless “magic link” sign-in by e-mail verification, or the alternative Trustee authentication.
- Encryption at rest, using CouchDB with TweetNaCl cryptography.
- Progressive Web App design that can keep working offline and sync later.
- FHIR API endpoints for Patient, Condition, MedicationStatement, AllergyIntolerance and Immunization, plus timeline and Markdown document endpoints.
- User-specific text snippets and templates for faster note writing.
- PDF viewing and editing, Highcharts graphs and growth charts.
- Care-opportunity alerts based on USPSTF preventive-care guidelines.
How dental teams use it
NOSH has no tooth chart, dental codes or imaging features. Its realistic role around dentistry is experimental.
Prototype a patient-held medical summary
- Deploy NOSH 3 on a test server with Docker.
- Enter fictitious patients with conditions, medications, allergies and immunisations.
- Query the FHIR endpoints to see how a dental clinic system could read a structured medical history.
Teach EHR and FHIR concepts
- Use a local install in a health-informatics or dental-informatics class.
- Compare NOSH’s FHIR-native data model with a traditional relational EHR.
- Do not use it for real patient data without a security review.
Install and first run
- NOSH 3 (Docker): copy the project’s docker-compose.yml, create a .env file with CouchDB credentials, the authentication method (Magic or Trustee) and optional API keys for UMLS and USPSTF services, then start the stack. It bundles Traefik for routing, CouchDB, the NOSH app and Watchtower for automatic container updates.
- NOSH 2: Docker was the recommended route; a shell-script install for Linux and macOS also exists; the old Ubuntu PPA is deprecated. It needs Apache, MySQL, PHP and tools such as ImageMagick and PDF Toolkit.
- Clients: any Windows, Mac or Linux computer with a modern browser.
Gotchas: the README asks you to register a domain name with a wildcard DNS record before installing; magic-link sign-in uses an API key from the external Magic service; Watchtower pulls updates automatically, which you may want to disable for predictable behaviour; and since there are no tagged releases, you are running whatever is on the main branch.
Limitations
- Dormant: no code changes since March 2025 and no formal releases.
- No dental features at all.
- Single-maintainer project with no commercial support.
- The NOSH 3 documentation does not describe scheduling or billing modules, which NOSH 2 had.
- No regulatory certification claims in the official repositories.
NOSH ChartingSystem vs alternatives
For a maintained open-source record, GNUmed is the safest choice. OSCAR EMR is a more complete web EMR, though OSCAR 19 itself has reached end of maintenance. If your interest is the FHIR/openEHR data layer rather than a user interface, look at EHRbase, an actively developed openEHR server. None of these is dental charting software.
FAQ
What is the NOSH charting system?
It is an open-source EHR designed by a family physician to be fast and intuitive, now in its third generation as a FHIR-native web app.
Is NOSH EHR free?
Yes. The software is free and open source under the AGPL. You pay only for your own hosting.
Is there a NOSH dental plugin?
No. No dental plugin or odontogram exists in the official repositories.
How do I install NOSH?
For NOSH 3, use the Docker Compose setup described in the GitHub README; for the older NOSH 2, the nosh-in-a-box project and README describe Docker and script installs.
Does NOSH run on Mac or Windows?
Users need only a browser on any system. The server side runs in Docker, which is usually hosted on Linux.
Is NOSH still maintained?
Not actively. The last code update in the NOSH 3 repository was in March 2025.
Last checked against official sources: 29 September 2026 (developer website: github.com). Versions and licence terms change — confirm on the developer's site before deploying in a clinic.
