OpenEMR on Google Cloud Run

OpenEMR is the world's most widely adopted open-source Electronic Health Records (EHR) and practice management system, used by 100,000+ healthcare providers across 100+ countries. This module deploys OpenEMR on Cloud Run v2 on top of the App_CloudRun foundation, which provisions and manages the shared Google Cloud infrastructure.

This guide focuses on the cloud services OpenEMR uses and how to explore and operate them from the Google Cloud Console and the command line. For the mechanics common to every Cloud Run application — service identity, ingress and load balancing, scaling and concurrency, CI/CD, Cloud Armor, IAP, Binary Authorization, VPC Service Controls, backups, and the deployment lifecycle — refer to the App_CloudRun foundation guide rather than repeating them here.

---

1. Overview

OpenEMR runs as an Apache/PHP 8.3 FPM container on Cloud Run v2. The deployment wires together a focused set of Google Cloud services:

Capability	Google Cloud service	Notes
Compute	Cloud Run v2	Apache/PHP service, 2 vCPU / 4 GiB by default, request-based autoscaling
Database	Cloud SQL for MySQL 8.0	Required — OpenEMR does not support PostgreSQL
Patient documents	Filestore (NFS)	sites/ directory with patient documents, session cache, and application state shared across all instances (gen2 required)
Object storage	Cloud Storage	A general-purpose data bucket
Session store	Redis	Enabled by default; falls back to the NFS server IP when no Redis host is given
Secrets	Secret Manager	Auto-generated admin password (OE_PASS) and database password (MYSQL_PASS)
Ingress	Cloud Run URL / Cloud Load Balancing	Default run.app URL, optional external HTTPS load balancer + custom domain

Sensible defaults worth knowing up front:

• MySQL 8.0 is mandatory. Selecting PostgreSQL or NONE breaks startup.
• NFS is mandatory and requires gen2. OpenEMR's sites/ directory — containing sqlconf.php, patient documents, Twig/Smarty caches, and uploaded files — must be on a shared NFS volume mounted via the Cloud Run gen2 execution environment.
• The startup probe is TCP, not HTTP. Cloud Run health traffic arrives over plain HTTP. OpenEMR's Apache/PHP stack may not yet be serving HTTP during the first-boot installation phase, so an HTTP probe would time out. A TCP probe checks only that the port is open and allows the installer to complete.
• First-boot installation is automated and slow. On first deploy, two initialization jobs run — nfs-init (NFS directory setup and optional backup restore) and db-init (MySQL user and database creation) — after which the container itself runs auto_configure.php to install the database schema. This can take 5–20 minutes.
• The OpenEMR admin password is generated automatically and stored in Secret Manager; you never set it in plain text.
• min_instance_count defaults to 1. Scale-to-zero is not recommended for clinical EHR systems — cold starts add latency that clinicians may interpret as a system failure.
• max_instance_count defaults to 1. Increase only after confirming Redis session sharing is operational; multiple instances without Redis cause PHP session loss.

---

2. Google Cloud Services & How to Explore Them

All commands assume PROJECT and REGION are set. Service and resource names are reported in the deployment Outputs.

A. Cloud Run — the OpenEMR service

OpenEMR runs as a Cloud Run v2 service. Each deployment creates an immutable revision; traffic can be split across revisions for staged rollouts. The service requires the gen2 execution environment for NFS volume support.

• Console: Cloud Run → select the service for revisions, traffic, logs, and metrics.
• CLI:

  gcloud run services list --project "$PROJECT" --region "$REGION"
  gcloud run services describe <service-name> --project "$PROJECT" --region "$REGION"
  gcloud run revisions list --service <service-name> --project "$PROJECT" --region "$REGION"

See App_CloudRun for scaling, concurrency, execution environment, and traffic splitting.

B. Cloud SQL for MySQL 8.0

OpenEMR stores all clinical data in a managed Cloud SQL for MySQL 8.0 instance. The service connects privately through the Cloud SQL Auth Proxy over a Unix socket (no public IP). On first deploy the db-init Cloud Run job creates the application database and user; the nfs-init job prepares the NFS sites/ directory.

• Console: SQL → select the instance for connections, backups, flags, metrics.
• CLI:

  gcloud sql instances list --project "$PROJECT"
  gcloud sql instances describe <instance-name> --project "$PROJECT"
  gcloud sql connect <instance-name> --user=<db-user> --project "$PROJECT"

The instance name, database, user, and password secret are in the Outputs. See App_CloudRun for the connection model, backups, and password rotation.

C. Filestore (NFS) and Cloud Storage

OpenEMR's sites/ directory is written to a Filestore (NFS) share mounted into the service at /var/www/localhost/htdocs/openemr/sites. This directory contains sqlconf.php (which signals installation completion), patient-uploaded documents, and Twig/Smarty template caches. All instances must share the same NFS mount. A general-purpose Cloud Storage bucket is also provisioned.

• Console: Filestore → Instances; Cloud Storage → Buckets.
• CLI:

  gcloud filestore instances list --project "$PROJECT"
  gcloud storage buckets list --project "$PROJECT"
  # Inspect the nfs-init job execution logs:
  gcloud run jobs executions list --job nfs-init --project "$PROJECT" --region "$REGION"

See App_CloudRun for the NFS mount, GCS Fuse, and CMEK.

D. Redis session store

Redis backs OpenEMR's PHP session store. When redis_host is left empty and NFS is enabled, the NFS server's co-located Redis instance is used automatically. In multi-instance deployments, a shared session store is required to prevent session loss.

• Console: Memorystore → Redis (if using a managed Memorystore instance).
• CLI:

  redis-cli -h <redis-host> ping
  redis-cli -h <redis-host> info keyspace

E. Secret Manager

The OpenEMR admin password (OE_PASS) and the MySQL database password (MYSQL_PASS) are stored in Secret Manager and injected into the service at runtime. Plaintext never appears in configuration.

• Console: Security → Secret Manager.
• CLI:

  gcloud secrets list --project "$PROJECT"
  # Retrieve the admin password to log in for the first time:
  gcloud secrets versions access latest \
    --secret=<admin_password_secret_id> --project "$PROJECT"

The admin password secret ID is exposed as the admin_password_secret_id output. See App_CloudRun for injection and rotation details.

F. Networking & ingress

The service is reachable at its run.app URL by default. An external HTTPS load balancer with a custom domain, Cloud CDN, and Cloud Armor can be layered on top. Ingress settings and VPC egress control traffic to/from the service.

• Console: Cloud Run (service URL); Network services → Load balancing.
• CLI:

  gcloud run services describe <service-name> --region "$REGION" \
    --format='value(status.url)'
  gcloud compute addresses list --project "$PROJECT"

See App_CloudRun.

G. Cloud Logging & Monitoring

Container logs flow to Cloud Logging; Cloud Run and Cloud SQL metrics flow to Cloud Monitoring, with optional uptime checks and alert policies.

• Console: Logging → Logs Explorer; Monitoring → Dashboards / Alerting.
• CLI:

  gcloud run services logs read <service-name> \
    --project "$PROJECT" --region "$REGION" --limit 50

---

3. OpenEMR Application Behaviour

• Two initialization jobs run on every deploy.

  Job	Purpose	Image
  nfs-init	Prepares the NFS sites/ directory structure, sets ownership to UID 1000 (Apache), and optionally restores a backup when backup_uri is set	google-cloud-cli:alpine
  db-init	Creates the MySQL database and application user	mysql:8.0-debian

  Inspect the jobs and their executions:

  gcloud run jobs list --project "$PROJECT" --region "$REGION"
  gcloud run jobs executions list --job nfs-init --project "$PROJECT" --region "$REGION"
  gcloud run jobs executions list --job db-init --project "$PROJECT" --region "$REGION"

• First-boot schema installation takes 5–20 minutes. After the init jobs complete, the service container runs auto_configure.php to install the OpenEMR database schema and create the admin account. During this phase a temporary PHP built-in web server serves HTTP 200 on the startup probe path, preventing the instance from being killed while the installer runs.

• Startup probe is TCP. The Cloud Run startup probe defaults to TCP on port 80 to avoid false failures during the first-boot installation phase when Apache/PHP may not yet be serving HTTP responses.

• Version-aware upgrades. On subsequent deployments the startup script compares the image version against the NFS-stored version and runs the appropriate upgrade scripts (fsupgrade-N.sh) automatically.

• Admin login. The initial administrator username is admin. The password is auto-generated and stored in Secret Manager — retrieve it with:

  gcloud secrets versions access latest \
    --secret=<admin_password_secret_id> --project "$PROJECT"

  If the admin account is locked after failed login attempts, use the /root/unlock_admin.sh <new_password> utility from inside the running container.

• HIPAA considerations. OpenEMR stores Protected Health Information (PHI). For HIPAA-regulated deployments, enable enable_iap or enable_cloud_armor to restrict access, set enable_audit_logging = true, and raise backup_retention_days to at least 90.

---

4. Configuration Variables

Variables are grouped exactly as they appear on the deployment platform. Only settings specific to or notable for OpenEMR are listed; every other input is inherited from App_CloudRun with its standard behaviour.

Group 1 — Project & Identity

Variable	Default	Description
project_id	(required)	Target Google Cloud project.
region	us-central1	Region for the service and regional resources.

Group 2 — Deployment Environment

Variable	Default	Description
tenant_deployment_id	demo	Short suffix that makes resource names unique per environment.
support_users	[]	Emails granted project access and monitoring alerts.
resource_labels	{}	Labels applied to all resources.

Group 3 — Application Identity

Variable	Default	Description
application_name	openemr	Base name for resources. Do not change after first deploy.
display_name	OpenEMR	Friendly name shown in the Console.
description	(set)	Service description.
application_version	7.0.4	OpenEMR image version tag; increment to deploy a new release.

Group 4 — Runtime & Scaling

Variable	Default	Description
deploy_application	true	Set false to provision infrastructure only without deploying the container.
cpu_limit	2000m	CPU per instance; 2 vCPU recommended for concurrent clinical workloads.
memory_limit	4Gi	Memory per instance; 4 GiB recommended. Below 2 GiB causes OOM kills under clinical load.
min_instance_count	1	Minimum instances. Keep ≥ 1 to avoid cold-start delays for clinical users.
max_instance_count	1	Increase only after confirming Redis session sharing is operational.
container_port	80	OpenEMR/Apache listens on port 80.
execution_environment	gen2	Must remain gen2 for NFS volume support.
timeout_seconds	300	Max request duration. Increase for report generation or large file uploads.
traffic_split	[]	Split traffic across revisions for staged rollouts.
max_revisions_to_retain	7	How many old revisions to keep.

Group 5 — Access & Ingress Control

Variable	Default	Description
ingress_settings	all	Which networks may reach the service. Use internal-and-cloud-load-balancing for HIPAA deployments fronted by a load balancer.
vpc_egress_setting	PRIVATE_RANGES_ONLY	How outbound traffic is routed through the VPC connector.
enable_iap	false	Require Google sign-in via Identity-Aware Proxy. Recommended for clinical-staff-only access.
iap_authorized_users / iap_authorized_groups	[]	Who may access through IAP.

Group 6 — Environment Variables & Secrets

Variable	Default	Description
environment_variables	{}	Extra non-secret settings. Core MYSQL_* and OE_* values are set automatically. Common additions: PHP_MEMORY_LIMIT, SMTP_HOST, SMTP_PORT.
secret_environment_variables	{}	Map of env var → Secret Manager secret name. Use for sensitive values such as SMTP credentials.
secret_propagation_delay / secret_rotation_period	(set)	Replication wait / rotation cadence.

Group 7 — Backup & Restore

Variable	Default	Description
backup_schedule	0 2 * * *	Automated backup cron (UTC). Do not disable for HIPAA-regulated deployments.
backup_retention_days	7	Retention; raise to 30–90 for production/compliance.
enable_backup_import	false	Restore from a backup on deploy.
backup_source	gcs	Import source: gcs or gdrive.
backup_uri	""	GCS URI (gs://bucket/path) or Google Drive file ID. When set, injected into nfs-init as BACKUP_FILEID.
backup_format	sql	Backup file format: sql, tar, gz, tgz, tar.gz, or zip.

Group 8 — CI/CD & Binary Authorization

Standard App_CloudRun Cloud Build / Cloud Deploy integration — see App_CloudRun. Key inputs: enable_cicd_trigger, github_repository_url, github_token, enable_cloud_deploy, enable_binary_authorization, binauthz_evaluation_mode.

Group 9 — NFS Instance & Custom SQL

Variable	Default	Description
nfs_instance_name / nfs_instance_base_name	(set)	Existing NFS instance / base name for an inline one.
enable_custom_sql_scripts / custom_sql_scripts_bucket / custom_sql_scripts_path / custom_sql_scripts_use_root	off	Run SQL from a GCS bucket after provisioning.

Group 10 — Domain, CDN, Cloud Armor & Image Retention

Variable	Default	Description
enable_cloud_armor	false	Provision Global HTTPS LB + Cloud Armor WAF.
application_domains	[]	Custom hostnames for the HTTPS load balancer.
enable_cdn	false	Enable Cloud CDN on the LB backend.
admin_ip_ranges	[]	CIDRs allowed privileged access.
max_images_to_retain / delete_untagged_images / image_retention_days	(set)	Artifact Registry cleanup policy.

Group 11 — Storage & Filesystem

Variable	Default	Description
enable_nfs	true	Must remain true. OpenEMR requires NFS for the sites/ directory.
nfs_mount_path	/var/www/localhost/htdocs/openemr/sites	Mount path. Must match the OpenEMR sites directory.
create_cloud_storage / storage_buckets / gcs_volumes	(set)	Data bucket / additional buckets / GCS Fuse mounts.
manage_storage_kms_iam / enable_artifact_registry_cmek	false	CMEK options.

Group 12 — Database Backend

Variable	Default	Description
database_type	MYSQL_8_0	Fixed — do not change. OpenEMR requires MySQL.
db_name	openemr	Database name. Immutable after first deploy.
db_user	openemr	Application user. Immutable after first deploy.
database_password_length	32	Generated password length (16–64).
enable_auto_password_rotation / rotation_propagation_delay_sec	off	DB password rotation.
db_host_env_var_name / db_name_env_var_name / db_user_env_var_name / db_port_env_var_name / service_url_env_var_name	""	Additional env var names under which connection details are injected.

Group 13 — Jobs & Scheduled Tasks

Variable	Default	Description
initialization_jobs	[]	Leave empty to use the built-in nfs-init / db-init sequence.
cron_jobs	[]	Recurring Cloud Run jobs invoked on a schedule.

Group 14 — Observability & Health

Variable	Default	Description
startup_probe	TCP on port 80, 12 failures × 10s	TCP startup probe. Avoids HTTP probe failures during the first-boot installation phase.
liveness_probe	HTTP GET /interface/login/login.php, 10 failures × 30s	Login page returns HTTP 200 only when the full stack is operational.
uptime_check_config	disabled	Cloud Monitoring uptime check. Enable explicitly once the service is reachable.
alert_policies	[]	Metric alert policies.

Group 21 — Redis Session Store

Variable	Default	Description
enable_redis	true	Use Redis for PHP session storage.
redis_host	""	Leave empty to use the NFS server IP; set explicitly for a dedicated Memorystore instance.
redis_port	6379	Redis port.
redis_auth	""	Optional Redis auth password (sensitive).

Group 22 — VPC Service Controls & Audit Logging

Variable	Default	Description
enable_vpc_sc	false	Enforce a VPC-SC perimeter. Requires organization_id to be set explicitly. Recommended for HIPAA environments.
vpc_cidr_ranges / vpc_sc_dry_run	(set)	Access level CIDRs / dry-run mode.
enable_audit_logging	false	Detailed Cloud Audit Logs (DATA_READ, DATA_WRITE). Recommended for HIPAA compliance.

---

5. Outputs

Returned on a successful deployment — the quickest way to locate and explore the running resources.

Output	Description
service_name	Cloud Run service name.
service_url	Default run.app URL of the service.
service_location	Region the service runs in.
stage_services	Stage-specific service URLs (Cloud Deploy).
load_balancer_ip / load_balancer_url	External HTTPS load balancer IP / URL (when enabled).
admin_password_secret_id	Secret Manager secret ID for the OpenEMR admin password (OE_PASS).
database_instance_name	Cloud SQL instance name.
database_name / database_user	Application database name / user.
database_password_secret	Secret Manager secret holding the DB password (MYSQL_PASS).
database_host / database_port	DB endpoint / port.
nfs_server_ip	Internal IP of the NFS server (sensitive).
nfs_instance_tags	Network tags of the NFS instance.
nfs_mount_path	NFS mount path inside the container.
nfs_share_path	NFS share path on the server.
nfs_setup_job	Name of the NFS setup job.
storage_buckets	Created Cloud Storage buckets.
network_name / network_exists / regions	VPC network, presence, regions.
container_image / container_registry	Deployed image and Artifact Registry repo.
monitoring_enabled / monitoring_notification_channels / uptime_check_names	Monitoring status, channels, uptime checks.
initialization_jobs	Names of the setup jobs.
deployment_id / tenant_id / resource_prefix	Naming identifiers.
project_id / project_number	Project identifiers.
cicd_enabled / github_repository_url / github_repository_owner / github_repository_name / cicd_configuration	CI/CD status and details.
artifact_registry_repository / cloudbuild_trigger_name / cloudbuild_trigger_id	Registry and build trigger.
vpc_sc_enabled / vpc_sc_perimeter_name / vpc_sc_dry_run_mode	VPC-SC status.
audit_logging_enabled / artifact_registry_cmek_enabled	Audit logging and CMEK status.

---

6. Configuration Pitfalls & Sensible Defaults

Risk: Critical (data loss / outage / security) — High (service degraded) — Medium (cost or partial degradation) — Low (minor).

Setting	Sensible value	Risk	Consequence if wrong
enable_nfs	true	Critical	OpenEMR cannot function without NFS. The sites/ directory, sqlconf.php, and patient documents all live on NFS. Disabling causes immediate startup failure.
nfs_mount_path	/var/www/localhost/htdocs/openemr/sites	Critical	Must match the OpenEMR sites directory path. A mismatch means nfs-init prepares the wrong location and the container never finds a configured sqlconf.php.
execution_environment	gen2	Critical	gen1 does not support NFS mounts; the service fails to start.
database_type	MYSQL_8_0	Critical	OpenEMR requires MySQL; PostgreSQL or NONE breaks the installer and all PHP database calls.
db_name / db_user	set once	Critical	Immutable after first deploy; renaming recreates the DB/user and destroys all patient data.
enable_backup_import	false unless restoring	Critical	Enabling without a valid backup_uri fails the import job and can corrupt the NFS sites directory.
backup_schedule	0 2 * * *	Critical	Disabling backups for an EHR containing PHI is a HIPAA compliance violation.
startup_probe	TCP (default)	High	An HTTP probe fails during the first-boot installation phase when Apache has not yet started fully, causing Cloud Run to restart the container before setup completes.
enable_redis	true	High	Multiple instances with isolated PHP session stores cause session loss and login failures for clinical users.
redis_host	"" (NFS) or explicit	High	An unreachable Redis host causes PHP session failures and prevents all logins.
memory_limit	≥ 4Gi	High	OpenEMR PDF generation and billing reports are memory-intensive. Below 2 GiB causes OOM kills mid-request.
min_instance_count	1	High	Scale-to-zero adds cold-start latency and risks missed clinical access.
backup_retention_days	7 (raise for prod)	Medium	HIPAA-regulated environments should retain at least 90 days.
enable_iap / enable_cloud_armor	enable for healthcare	Medium	The OpenEMR admin interface and patient records are publicly reachable without these controls.
enable_audit_logging	true for HIPAA	Medium	HIPAA requires audit logging of access to PHI.

---

For the foundation behaviour referenced throughout — service identity, scaling and concurrency, ingress and load balancing, CI/CD, Cloud Armor, IAP, Binary Authorization, VPC-SC, backups, and image mirroring — see App_CloudRun. OpenEMR-specific application configuration shared with the GKE variant is described in OpenEMR_Common.