Nowadays the Electronic Health Records (EHRs) systems market has gained importance in healthcare systems. This paper presents an analysis of the level of implementation and the evolution of numerous commercial and open-source EHR systems in use today. We began the review by searching Medline terms such as EHR, “commercial electronic health records”, “open-source electronic health records”. We also looked in non-peer-reviewed literature by searching different search engines. Moreover, we identified providers and users from the different solutions and contacted them to obtain more information. The most important international barrier to the adoption of EHR systems is economic resources. The wealthiest countries opt to implement their own EHR systems. The commercial applications that currently have the greatest number of registered users are eclinicalworks, CareTracker and Allscripts Professional, all belonging to U.S. companies. The most commonly used open-source systems are HOSxp, OpenEMR and OpenVistA. The first two are implemented, in general, on the African continent, Latin America and some countries in Asia. The implementation of an international and interoperable EHR platform is difficult to achieve because each country has a different level of development of these systems. Countries with few resources tend to implement open-source software systems and developed countries lean towards commercial EHR systems.