Wednesday, December 31, 2008

Banner Year for New OSCAR Installations

OSCAR has experienced a fantastic year of growth in 2008, which saw a 75% increase in new installations year/year from 2007.

While British Columbia users continue to be one of the most active and engaged OSCAR user communities, 2008 has turned out to be particularly interesting east of the Pacific as substantial numbers of new installations occurred in both Ontario and Quebec.

Congratulations to all involved in the OSCAR open source community. You are delivering world beating Electronic Medical Record, Clinical Management System, & Personal Health Record solutions, across Canada, for the benefit of all.

Saturday, December 27, 2008

Changing The Practice of Medicine

The NY Times has an excellent article discussing the computerization of the modern health practice and the benefits that come with being better equipped with timely information.
Across the national spectrum of health care politics there is broad agreement that moving patient records into the computer age, [...] is essential to improving care and curbing costs.

A paper record is a passive, historical document. An electronic health record can be a vibrant tool that reminds and advises doctors. It can hold information on a patient’s visits, treatments and conditions, going back years, even decades. It can be summoned with a mouse click, not hidden in a file drawer in a remote location and thus useless in medical emergencies.

Modern computerized systems have links to online information on best practices, treatment recommendations and harmful drug interactions. The potential benefits include fewer unnecessary tests, reduced medical errors and better care so patients are less likely to require costly treatment in hospitals.

The widespread adoption of electronic health records might also greatly increase evidence-based medicine. Each patient’s records add to a real-time, ever-growing database of evidence showing what works and what does not. The goal is to harness health information from individuals and populations, share it across networks, sift it and analyze it to make the practice of medicine more of a science and less an art.

The full article is well worth the read.

Tuesday, December 23, 2008

Counting Heads - How Many OSCAR Users?

The total number of OSCAR users, as it is an open source product which can be freely downloaded and redistributed, is hard to quantify, but here is what we know (as of November, 2008):
  • OSCAR has been downloaded over 15,000 times.

  • OSCAR has been installed in a number of countries including, Canada, US, Australia, Columbia, Brazil, Italy, and South Africa. Furthermore, the Brazilian government funded 10 developers to translate OSCAR into Portuguese.

In Canada,
  • OSCAR is being used within the Family Medicine units of McMaster University and McGill University, by the City of Toronto's Client Access to Integrated Services and Information (CAISI) Project, with rural doctors in Ontario and BC and a number of family practices and by both large and small clinics in the metropolitan areas around Vancouver, Toronto, and Hamilton.

  • The OSCAR community is aware of approximately 500 active OSCAR practitioners in Ontario, BC, Quebec and Prince Edward Island. Over 350 of these users are in Ontario.

  • OSCAR is commercially supported by a significant number of independent vendors, offering the end user a real choice in their selection of how they would like to support their own environments.

  • The OSCAR community continues to grow everyday.

Tuesday, December 16, 2008

Why Free Is Better

Why in our world of expensive commercial software would the free offering be superior and preferred?

It might surprise you, but it is not just about cost, although cost plays an important role.

Free has been used as a competitive deferrentiator for many years. Free makes people work harder and smarter and focus on the most important bits. Free drives innovation and adoption. Large numbers of more active and involved users drive rapid enhancements and technological advancement.

The technologies that underpin the Internet were made freely available, attracted large user bases, spawned rapid user-led and user-inspired enhancements, and the end result has been transformative to global society.

OSCAR is a freely licensed EMR. It is also the most compelling and competative offering on the market in Canada today.

Pound for pound, feature for feature, you can do no better. OSCAR is as good, if not better, than every single commercial offering in Canada, and it doesn't cost a dime.

Large numbers of doctors across Canada use OSCAR every day. These same doctors continually improve OSCAR by making suggestions and contributing energy and effort to ensure OSCAR remains the best EMR.

Just like the Internet itself, OSCAR is improved everyday by its users, and that is why free is better.

Monday, December 8, 2008

Mobile Personal Health Record

The Mobile Personal Health Record is a proposed project directed at making the myOSCAR Personal Health Record available via your mobile device:

The goal of the project is to create a mobile extension of an open source personally controled health record platform, which will facilitate the recording of personal health data, the personal use of evidence based health protocols via a "plug-in" approach and the empowerment of the individual to interact more effectively with the health ecosystem in managing their health.

This project is currently being considered for USAID funding, which will be decided via public balloting, Dec. 8 - 12, 2008.

Please consider voting for this important effort.

OSCAR User Interview: Dr. John Yap

Dr. John Yap, Royal City Family Practice, New Westminster, BC

My practice is in New Westminster, B.C. Originally, I worked with 2 other GP's in a medical building, but 11 years ago we relocated to a nearby mall, and picked up another GP along the way. We had a foursome going until about 5 years ago, when one of our partners decided to return to his native Ireland.

How long have you been using OSCAR?

I joined my current practice in 1990, taking over an existing practice that was 30+ years old. One of the reasons the departing GP was retiring, I found out, was that he did not want go through the headache of upgrading his charting. Charts were literally bursting at the seams! It took me over a year to separate all the family members out of a single chart! I could see the pattern repeating with me. As the charts were getting unmanageable, the amount of paper work that required filing became increasingly greater. I started using OSCAR for charting and scheduling in early October 2008.

Did you have prior EMR experience before OSCAR?

About 5 years ago, there was a proposal from the government and BCMA to get GP's doing more chronic disease management. Diabetes was the target disease. The program required an EMR of some sort, and Nightingale was the vendor chosen. The costs of the software were to be covered by the pilot project, but the ongoing costs seemed a bit high at the time. The hardware also seemed unaffordable. Remember, this was 5 years ago, and technology was way more expensive and less powerful than now.

As my charts got bigger, I would summarize them in a Word document, and put the old data into an inactive Volume 2. This was very time consuming, but necessary as some charts wouldn't even fit in the chart slot on the door! I made it a habit of doing these summaries whenever new patients had their charts sent to me.

Can you tell us a bit about your office and how it is set up?

I was fortunate to be able to visit several offices over the past year to see how they were set up. I saw three OSCAR sites and one non-OSCAR site. The latter was a health authority pilot project, which received funding to be a beta test site. The GP using this EMR was not satisfied with the product, but there was no turning back. I'm not sure what the situation is today. The OSCAR sites ranged from a complete "do it yourself" office, retrofitted and added to over the years, to a "planned from the bottom up to accommodate OSCAR" office. The latter office was the most high-tech office I had ever seen. It was "overbuilt" with future expansion in mind. It was a very slick operation, indeed. I was aiming for something in the middle.

My office, being in a mall, has some constraints, mainly becuase it is one long hallway. Each GP has 2 examining rooms, and a separate personal office. With one less partner, we were able to convert the extra office into to a server room!

To get started quickly, and to reduce some costs (hopefully!), I decided to go wireless. I wanted workstations in each exam room, and felt that a laptop in the office would give me portability, and a back-up if any of the workstations crashed. I have always used PC's, but decided this was a good time to switch to Mac's. My partner decided to keep to PC's.

My exam rooms have a Mac Mini, with wireless mouse and wireless keyboard on the counter. The 19" monitor is wall-mounted, and swivels to allow for private or collaborative viewing. I have a USB-connected printer in each room. We also have a networked printer for the office at the MOA station. The neatest part of my set up is the absence of a visible CPU. The computer is in the cupboard, locked away. The only wires seen are from the monitor, which lead into the locked cupboard. It's a very clean look! I had to do all the drilling, cutting, wiring, and lock installation myself. It took a couple of weekends to finish. If I had to do it again, I'd pay someone else to do it!

The MOA's have their own workstations, and are connected to a networked printer. One is using an Acer PC (Costco-bought), and the other has an iMac. We have a Fujitsu S510 desktop scanner connected to the Acer for now. We would like to have some sort of PC-based faxing system.

Now that you have been using the system for a while, would you go back to paper?

It's been about 6 weeks since I started typing my notes and printing my forms, letters, and prescriptions. I no longer have to duplicate my work by copying prescription and lab requisition details back into the chart. I can foresee how searching for information in the chart will be a snap in the future. Many patients comment that I'm finally going "paperless", but really, it is more accurate to state I'm going "less paper". I will never go back to paper!

What is your favourite feature?

I really like the prescription module. Sure, it's time consuming to input the data initially, but re-prescribing is a breeze. I even look forward to doing it! Plus, I was getting hand cramps from note taking, and my handwriting is atrocious! I haven't had hand dystonia in over 6 weeks! My initial plan was to start OSCAR with voice dictation, but I can type reasonably well, and Mac's don't really have great voice recognition software...yet. I'll stick with typing for now. My MOA loves the scheduler. The tickler system is great. No more missing Post-it notes!

How are you pushing yourself through the first few months transition, when learning the software was taking a lot of your time and effort?

Learning the software hasn't been that difficult. Sure, I've written in the wrong chart a few times, but that happened with paper charts too! I had a resident working with me a few weeks ago. We played with a test patient's chart on his first day, and he was up and running in 15 minutes. He loved the program. My MOA picked up on the scheduler easily too. It is way more reliable than the paper schedule...except when the wireless connection goes down, like it did last week!

How are you getting the initial patient data into the system?

I had my support person migrate my patient demographics from Osler, my billing program. This was not as easy or "clean" as I thought it would be. In our practice, we all used different programs. When we migrated our data over, we sometimes had 2 or 3 entries for the same patient. This would not happen if one were to manually input each patient, but it can if you load the demographics in with a migration process. That should be a warning for others who consider EMR's of any sort. I must have spent 100+ hours, outside of work, to identify these duplicates (triplicates, etc.) for deletion!

As each active patient comes in, I'm adding a bit more to the patient summary. We started getting labs imported electronically almost from day one. I plan on back-filling as many of the labs as possible, probably one year's worth, to get a good database going. We have not done a lot of scanning yet. We need another workstation, and probably another clerk to do this. It could be a good summer project for one our kids!

In retrospect, what would you have done differently during your transition to OSCAR?

Most offices are probably retrofitting their site to accommodate an EMR, rather than rebuilding. Ideally, a consultant could assess the needs of the GP/GP's and their budget, then advise what hardware and renovations would be needed, get the appropriate subcontractors in to do the work, order hardware, do the connections, migrate the data, etc. The doctor could simply show up for work on Monday, and everything would be working. If it could only be that pain free!

Despite losing a lot of sleep over it, I did learn a lot about computers, networks, wireless routers and the OSCAR program. Plus, I really know my way around Home Depot and RONA now!

Do you have any advice that you can give the new user as they prepare to make the move to an EMR?

For me, it was not a matter of if I would get an EMR, but when. The existing proprietary software seemed too expensive, especially 5 years ago when I was first introduced to the concept. However, after looking at OSCAR, and comparing it with other products, there is no reason not to get an EMR, even if retirement is looming in the next 5 years. If I was about to retire in a year or so, maybe I'd leave it to my successor. However, these days, it's probably not possible to get someone to take over your practice. Times have changed. I'd much rather look after several DVD's of data, than a basement full of charts!

We had one further challenge in our office. We have 3 GP's, and one is a bit of a techno-phobe who doesn't type well. He has yet to take the EMR plunge. He knows about voice dictation, and at one time he did have his notes typed and physically pasted into the paper charts. Nowadays, he always has piles of charts on his desk to complete, and I usually have a clean desk by the end of the day. I'll be reminding him of this frequently! So it is possible to proceed with an EMR, even if everyone isn't on board.

My original plan was to start OSCAR up during the early summer rather than in October, which is one of the busier times of year for me. However, having survived the busy flu shot season, I can honestly say it can be done at any time. And you don't have to do it all overnight. It took me 20 years to accumulate all this paper, it took me a year to separate out family charts into individual charts, and it'll probably take me 6 months or so to get the essential data into everyone's chart. After that, it only gets easier, not harder! Can't say that about paper!

Do you feel that the move to electronic records has improved your patient care?

Absolutely. Patient reminders are more reliable. Prescriptions are super easy to track. I'm actually documenting more thoroughly because I don't have hand cramps any more! The only time I use my pen is to sign my prescriptions. The patients are impressed with the technology. Plus, I have a screen saver showing beautiful landscape pictures while they wait for my entrance to the exam rooms.

Saturday, December 6, 2008

American Medical Informatics Association

See the announcement below. The American Medical Informatic Association have produced a
white paper on Free and Open Source (FOSS) in health care. It is well referenced and makes interesting reading. Two very interesting aspects of it for me are the data on use of FOSS in health care and the discussion of the pros and cons of FOSS and proprietary(closed source/secret) software.

I think this is a very important paper and should be read by/shown to, all health care managers who have any role in choosing/commissioning software.

links to the full pdf of the paper.

The American Medical Informatics Association (AMIA) Open Source
Working Group has released its Free and Open Source White Paper with
press release: "...Even the most skeptical interpretation of the
numbers presented on Free and Open Source deployments and patients
shows that these systems are being used in sizable numbers," said
Ignacio Valdes, MD, MSc the primary author of the paper and chair of
the AMIA Open Source Working Group. He continues, "This paper is for
practitioners, CIO's, IT staff, and policymakers making difficult
health IT decisions with valid concerns about cost, ethics,
interoperability, patient privacy, security and the future of their
organizations in the hands of proprietary software. This white paper
should be a must-read for every organization that uses or is
contemplating the use of Electronic Medical Records."

Complete text and links to the paper and press release

Thursday, December 4, 2008

The BC Health Passport

If you are an OSCAR user in British Columbia, then you already have access to the BC Health Passport, an innovation brought to the OSCAR community via the efforts of user Dr. Tracy Monk.

The BCHP auto-populates relevant patient information directly out of the patient record with the click of a button. One more click to print and your patient walks out of your office with their latest Personal Health Record summary folded into their purse or wallet.

To get access to this feature in your OSCAR, enable it via the Admin->Select Forms window.

Wednesday, December 3, 2008

Care in remote communities - and OSCAR

Today I went on my weekly visit to some remote reserve communities. Whilst there I connected to OSCAR in our office and accessed results, ordered tests, prescribed and charted as usual. All over a satellite internet connection (the communities have no telephones or grid electricity). Then the idea hit me. Usually I give folks their prescriptions or print them when I get back to the office and they get to the pharmacy by the next day. Folks have to travel up to the pharmacy to collect their medications. There is delay in that process. So today, I generated the prescriptions in OSCAR, had the office print them in Pemberton and get them to the pharmacy and then contacted one of the remote community members to pick the medications up so that they arrived in the communities the same day. Now......all we need is for pharmacies to be able to accept electronic prescriptions and then we will have really streamlined things.

Tuesday, December 2, 2008

Smoking Cessation Flow Sheet

OSCAR supports the Ontario Smoking Cessation Flow Sheet, allowing you to easily and electronically fill out and embed the document directly into the patient chart.

The Smoking Cessation Flow Sheet is another example of an OSCAR eform that can be quickly added to your OSCAR server.

Annual Meeting Pictures

Jel has posted a number of pictures of this year's annual OSCAR Usergroup meeting on his Flickr.

Sunday, November 30, 2008

Spotlight on eForms - Surface Anatomy

OSCAR has a vast collection of user contributed eForms that can be easily added to your own OSCAR system and modified to your specific requirements.

The Surface Anatomy eForm was contributed by Shelter Lee and allows you do make multi-coloured drawings on a surface anatomy diagram.

The background image is easily changed, so that you can re-purpose this form for drawing onto any type of diagram.

Saturday, November 29, 2008

Standing Room Only at the Second National OSCAR Usergroup Meeting

Significant delegations of OSCAR users, developers, and service providers from British Columbia, Quebec and Ontario met in Toronto today at the Family Medicine Forum 2008.

Members gathered to participate in a vibrant, all-day interactive session which included new feature demonstrations, user-led training, product roadmap prioritization and the annual OSCAR Canada Users Society general meeting.

New OSCAR users from across Canada are encouraged to join the OSCAR users discussion forums by visiting our community list and adding your email address.

If you missed the meeting, here's what you need to know:

  • There is a new echart that you should be using

  • The roadmap & wishlist are awaiting your input

  • Our users make and share the best Complex Care and other eforms

  • MyOSCAR and MyDrugRef are important efforts that you should consider adopting

  • OSCAR CAISI has been deployed in several urban areas in Ontario with the aim to reduce the plight of chronic homelessness by enhancing the integration of care between agencies at the individual and population levels using an electronic information system

  • The OSCARCanada website and the online OSCAR user manual are resources for you