The system is designed to be usable in very resource poor environments and can be modified with the addition of new data items, forms and reports without programming.

The first ideas and prototype of OpenMRS were conceived by Paul Biondich and Burke Mamlin from the Regenstrief Institute, Indiana on a visit to the Academic Model Providing Access to Healthcare (AMPATH) project in Eldoret, Kenya in February 2004.

Around the same time the EMR team at Partners In Health led by Hamish Fraser and Darius Jazayeri were looking at ways to scale up the PIH-EMR web-based medical record system developed to manage drug resistant tuberculosis in Peru,[9] and HIV in rural Haiti.

[10] Paul, Burke and Hamish met in September 2004 at the Medinfo conference in San Francisco, and recognized they had a common approach to medical information systems and a similar philosophy for healthcare and development and OpenMRS was born.

Most deployments are run by independent groups who carry out the work on the ground with technical support and training provided by the core team of OpenMRS developers, and other implementers.

OpenMRS is supported by core teams from Partners In Health, Regenstrief Institute, and the South African Medical Research Council.

Some institutes have extended financial and consulting support as well, including The United States Center for Disease Control, the Rockefeller Foundation, and the World Health Organization.

There are several groups of programmers working on OpenMRS in developing countries including Kenya, Rwanda, Uganda, South Africa, Pakistan, Chile, and India.

In Rwanda, Partners In Health started local training program called E-Health Software Development and Implementation (EHSDI).

The OpenMRS community includes developers, implementers, and users from multiple countries who collaborate through mailing lists, IRC, and annual conferences.

OpenMRS has participated annually in Google Summer of Code since 2007; according to that program's manager, it receives more student applications than the Apache Software Foundation.