ROOK alternative
Open Health Sync and ROOK side by side: price, sources, lab and health record data, FHIR R4, health scores, and when ROOK fits better.
Open Health Sync is an open source, self-hosted alternative to ROOK for wearable data. Both give your product one API for data from wearables and health apps. ROOK runs that API for you, adds lab results, medical devices and health records next to it, and charges a monthly plan. Open Health Sync is software you run yourself: one Go binary and Postgres, free under AGPL-3.0, with the data on servers you choose. It has no lab or health record data today.
This page compares the two and says when ROOK is the better pick. Facts about ROOK come from its own site and pricing page, checked on 2026-10-18. They change, so check tryrook.io as well.
At a glance
| Open Health Sync | ROOK | |
|---|---|---|
| What it is | Open source software you run | A hosted health data aggregation platform, sold as a subscription |
| License | AGPL-3.0 | Proprietary |
| Price | Free. You pay for your own server | Core: $399 a month for up to 750 active users. Core+: $999 for up to 5,000. Business: $1,999 for up to 15,000. Enterprise on request. Lab data billed apart, from $249 a month for 300 files (pricing) |
| Where the data is kept | Your Postgres and your raw store, for as long as you decide | ROOK's cloud. Dedicated servers on Enterprise |
| Sources | 13 available, 4 more on main for the next release (list) | 500+ devices through one integration advertised (its site also lists 72 data sources), plus medical devices |
| Garmin | Next release: a Health API connector (guide) for operators with their own Garmin app. Garmin has paused new developer access requests, per its replies to applicants. Garmin exports import as activity files (next release) | Yes |
| Lab results | No | Lab Data API, with biomarkers coded in LOINC and FHIR R4 output |
| Health records (EHR) | Planned, after the SDKs: SMART on FHIR patient access (connectors) | EHR/EMR API with FHIR R4 output, on a waitlist on the pricing page |
| Data model | One canonical model, one unit per quantity, UCUM units and LOINC codes (data model) | ROOK's normalized data |
| FHIR R4 | Built in, checked with the official HL7 validator (FHIR R4) | "Clinical Ready (FHIR R4)", an add-on on Core, included from Business |
| Open mHealth | Yes, checked against the official schemas (Open mHealth) | Not found on its site |
| Raw payloads | Every payload kept verbatim, so a mapping fix can re-process history | Not stated |
| AI agents | Read-only MCP server on your instance, over stdio or Streamable HTTP (MCP) | Not found on its site |
| Health scores | None: it keeps the scores providers send (readiness, recovery, strain) and computes none | ROOK Score (physical, sleep and body health), as an add-on or from Business |
| Mobile SDKs | Swift, Kotlin, React Native and Flutter, installed from the repository for now (SDKs) | The ROOK SDK, and the ROOK App when you cannot embed an SDK |
| Compliance | Not certified. It depends on how you run it (security model) | A HIPAA-aligned security program with BAAs, and GDPR as a data processor, per ROOK |
| Runs on | Linux, macOS, Docker, Kubernetes, a Raspberry Pi 5 | ROOK's cloud |
What it costs
ROOK's Core plan costs $399 a month for up to 750 active users, and Core+ $999 for up to 5,000. Past a plan's limit, billing follows usage at a rate the pricing page does not list. Lab data is billed by the number of files a month. ROOK offers a 30-day pilot and month to month plans.
Open Health Sync costs nothing to use. You pay for the server it runs on, and for any vendor program that charges developers (some partner programs do). It idles in about 22 MB of memory and runs on a Raspberry Pi 5 with 4 GB (benchmarks).
Pick ROOK when
- You need lab results or health records next to wearable data, in one API, with FHIR R4 output.
- You need Garmin today, or devices beyond the 13 sources here, under one contract.
- Your users cannot install your app: the ROOK App collects their data instead.
- You want ready-made health scores and threshold alerts (ROOK Score and ROOK Signals).
- You do not want to run a server, or to register a developer app with each vendor.
Pick Open Health Sync when
- The data has to stay on infrastructure you choose, for privacy, data residency or a regulator.
- Per-user fees do not fit: a free tier for your users, a research study, a non-profit, or your own data on a home server.
- You need standard output without add-ons: FHIR R4, Open mHealth and Parquet are built in.
- You want every original payload kept, so a fix in a mapper re-processes history instead of losing it.
- You want to read and change the code: see how a value was converted, fix a mapper, add a source.
- You want an AI agent to read the data through a read-only MCP server you control.
Moving from ROOK
ROOK's public pages describe its products but not their routes, so there is no route by route
mapping here. In Open Health Sync, each person is a user (POST /v1/users with your own
external_ref), connects providers through a hosted page
(POST /v1/users/{id}/connect-sessions), and their records are read from samples, sleep,
workouts and daily under GET /v1/users/{id}/... (API). The data.written
webhook tells your server what changed (webhooks). For each cloud provider,
register your own developer app and set its keys (connectors).
Try it
The quickstart starts an instance with Docker Compose and fills it with 90 days of synthetic data from six sources, so you can call every route before you connect a real account.
See also: all the options compared, Terra API alternative and Open Health Sync vs Open Wearables.