Getting Started With OSCAR - What You Need

To get your practice up and running with OSCAR, You will need to consider and source the following products and services.

1. OSCAR servers – The typical clinic will deploy two redundant and resilient OSCAR servers in the office and, optionally, a third server at an offsite location for automated offsite backup. Your practice is a real time environment and you can not afford to have your EMR halt whilst humans continue to show up in your lobby every few minutes. Server redundancy and a robust backup strategy is a good thing.
2. OSCAR support – You will need an annual support contract to ensure that your practice continues to run smoothly. This support is just as critically important as having a robust server backup strategy. You should ensure that your annual support includes telephone and email support, annual software updates and 24/7 emergency coverage.  
3. OSCAR training – Both practitioners and staff will require specialized training to enable them to efficiently and correctly use OSCAR. You should plan for a minimum of staff training consisting of 2 x 3 hr sessions to cover basic functionality and 2 x 3 hr sessions to cover basic billing. Practitioner training commonly consists of 2 x 3 hr sessions to cover basic usage. Both practitioners and staff may elect to receive additional advanced level training. 
4. OSCAR installation – Considering the risks associated with having a poorly installed EMR sitting exposed on an unsecured network, you should consider professional installation and configuration. You should ensure that you are comfortable and confident in your environment's security before entering any sensitive medical information into your EMR.
5. OSCAR data conversion – Most established clinics move their demographic information into OSCAR. Some clinics will additionally move their billing histories, their appointments and schedule histories, and/or their electronic patient charts. Conversion continues to be "more art than science", and so it is important to understand what you will convert and what it will look like when it arrives on the new system. 

Depending on what infrastructure you currently have, there are additional items that you may need to purchase beyond the EMR that are not included above. These items may include additional user workstations, laser printers, documentation scanners, magnetic card readers and an uninterruptable power supply. In addition, your office will very likely need to be connected to the Internet, and additional phone lines may be required for billing and labs access.

What To Expect When You Are Expecting

When starting down the EMR path, there are a number of things that you need to consider.

Technology has the ability to improve the way you practice and interact with your patients. Technology also has the ability to degrade your practice and your patient interaction. There are no one-size-fits-all models that works for everyone.

Implemented well, you will become very happy with your new EMR and the ways that it aids in your patient care. However, with a poorly implemented EMR, you will soon pine for the "good old days", except they will never come back.

It is important to start with an open mind, a willingness to continue to adapt your strategy until you find what works best for you and your patients, and a similar willingness to abandon strongly held convictions on how things should be done, when clearly they are not working.

When adopting an EMR, join your user community and learn from those that came before you. Talk with practitioners that are using other EMR products too, as they may be able to give you insights to how different systems perform similar tasks.

Ask "why?". Ask "how?". Keep asking until you are comfortable with the answers.

Be skeptical. Don't believe what your vendor tells you just because they sound convincing. Don't believe what the government is telling you just because they too sound convincing. Ask critical questions. Apply critical thought. If it doesn't make sense, keep asking questions until it does. Check your facts and get references.

Engineers love to use Three Letter Acronyms (TLAs) just to confuse you. If you don't know what a WPA2-AES is, or why you would be a fool to move forward without using it, then ask. The same is true for hundreds of exotic sounding terms and TLAs associated with your new software. If your support team can't or won't explain plainly and simply the technology, then get a new support team.

You use technology everyday. Your mobile phone - lots of technology there. The cash machine in front of your bank - never read that user manual. Watching Star Trek parodies on YouTube - brought to you by 100 million lines of complex software. Everyday you are immersed in astounding complexity, however you've learned to live with it, to turn the utterly magical into the simply benign.

An EMR is an incredibly complex piece of industrial infrastructure. This complexity is why Health Canada and other national regulators have identified EMRs as Class II Medical Devices. These systems have come a long way from being just a replacement to your weekly shipment of paper.

After deploying an EMR in your practice you and your staff will go through a complex transformation from the old world to the new world. Many of your colleagues have already made the transition and many more are about to embark on the same journey as you.

You will be successful in modernizing your clinic if you take your time, move methodically, and remember to breathe.

Breathe, and continue to ask "why?".

A Billion Dollars Here, A Billion Pounds There

Canada isn't the only jurisdiction wrestling with billion dollar e-health boondoggles as it turns out.

Only 175 people using flagship NHS software, says minister

Lorenzo care records system is likely to be costing taxpayer hundreds of thousands of pounds per user per year

Recent news from the UK has identified that very few people are actually using one of the only two systems being brought in by the government to manage patient information.

There are only 174 clinicians using Lorenzo patient software across the five early adopter trusts, according to Mike O'Brien, minister for the National Programme for IT (NPfIT).

Five Boroughs Partnership, Bradford Teaching Hospitals NHS Foundation Trust, University Hospitals of Morecambe Bay, Hereford Hospitals and South Birmingham have only ever had 19 clinicians using the systems at the same time.

Lorenzo is one of two software packages being used to set up centralised electronic health records as part of the £12.7bn National Programme for IT. This part of the programme is already running four years late.

Lorenzo is being supplied by services company CSC to trusts in the north of England and by its developer iSoft directly to trusts in the south after Fujitsu was fired from the programme.

The other patient software package is Cerner Millennium, being supplied by BT in London and a handful of trusts in the south.

The information came from a parliamentary question tabled by Richard Bacon MP.

Last week in the Commons he said:

"I tabled a question yesterday about the number of hospital trusts where Lorenzo has been partially deployed, asking how many users — how many concurrent users — of Lorenzo there are.

"It is literally just a handful, which means that the cost per user is not what one would expect… the cost is going to be many hundreds of thousands — possibly even more than a million — pounds per user per year."

£1,000,000 per user, per year. (That's about $1.75 million dollars in Canada. Per user, per year.)

I guess they haven't heard of OSCAR.

Saving Healthcare From Demographic Demise

Harvard has posted a total package of information from the 2009 HIT Platform meeting.

We discussed this meeting in a prior post, and if you want a quick summary, this is a good place to start.

There are two major components of information available on Harvard's ITdotHealth website:

1.       the detailed meeting summary

http://www.itdothealth.org/wp-content/themes/atahualpa/images/header/HMS-HIT-Platform-final-v110909.pdf

2.       and presentation videos and photos

 http://www.itdothealth.org/multimedia/2009-hit-platform/#videos

If you only have time and space in your mind for one thing from this conference, please spend it on the keynote presentation from Clayton Christensen. In his keynote, he clearly articulates in very simple terms how healthcare will need to change in order to avoid complete financial disaster in the future.

Of Standards and Certifications

Much discussion is going on in the web-o-sphere these days about Health Canada's recent decision regarding the classification of EMR products as a Class II Medical Device.

Working within the regulatory frameworks of various jurisdictions are a normal way of life for many software applications, and OSCAR continues to meet and exceed these regulations on a regular basis.

Because of OSCAR's unique role in numerous social communities and academic organizations, the platform has always been at the forefront of technology, capability, privacy, and regulation.

In many cases, OSCAR leads the industry in terms of practice management. For example, OSCAR's efforts concerning security and privacy enhancing technology, especially as it pertains to delivering control and consent to clients over their own medical information, continuously shines as an example for others to follow.

It is no surprise then, that the OSCAR community continues to invest to achieve all relevant certifications for all jurisdictions that the software is deployed.

The 68% Solution

The issue of data portability is the single largest future problem that we need to address today if we have any hope of saving ourselves from our self imposed enslavement to our EMR platforms.

It is without doubt that our governments understands this.

The creation of the OntarioMD CMS v3.0 specification specifically ensures that compliant solutions will have to provide both import and export functions for a core patient data set.

In concept, this sounds very powerful. With the current standard, you are able to export and import data from any certified vendor EMR into any other certified EMR solution.

Unfortunately, this standard does not protect the doctor from EMR lock in. Unfortunately, this standard only perpetuates the problem.

It doesn't matter if today you have the most super-amazing-incredibly-awesome EMR ever invented. Are you willing to wager that your EMR will always be the very best? Forever? Forever and ever?!?

If you are not careful you will potentially chain yourself to your EMR for the rest of your life!

By defining a standard based on the concept of a finite core data set, one guarantees that valuable information will never be able to be moved from one system to another. Stated another way, by the very definition of the data set, by the identification of a finite set of important information, the government has ensured that anything not in this data set will not be abled to be moved.

By standardizing a core data set, we are making a bet on what information will be important to future medical applications. Who can predict what will be important in the future? We can guess, extrapolate, hypothesis, but we can not be sure.

The core data set is a 68% solution.

The future of your practice and the health of your patients may depend on information captured in the other 32%.

We do not live in the world of finite solutions, finite concepts, finite applications, or finite innovation. We live in a world of constant innovation, of constant refinement to what we deem important.

To make matters worse, day by day, the data pie keeps growing. The core data set, over time, will become less and less relevant. Unfortunately, this is guaranteed by the very definition put in place to protect us.

We applaud efforts to ensure data portability, however we encourage our government to go all-in: require all vendors to guarantee that 100% of the data you enter into you EMR is able to be extracted whenever you feel like doing it.

(While you are doing this, please legislate that software bombs must not be included in medical software systems -- their inclusion is morally reprehensible and those vendors that use them should be ashamed of themselves.)

100% data portability is an easy standard to define. It is future proof. Once implemented, it never has to be revisited.

If all vendors are required to make available all data at all times under all circumstances, you will be able to move to new technologies in the future, to new applications that haven't even been dreamed up yet, to new applications that will transform the way you will live, work, and practice medicine.

Today, we don't need to know what the applications will be. Today, we know with absolute certainty that they will come. We don't know what data sets these fantastic new tools will require. How could anyone know this? These brilliant new tools haven't been invented yet.

But there is one thing we do know. We know that high tech innovates on an every increasing cycle. The current technology world reinvents itself every 3 years or so.

For example, Twitter was founded in 2006. Who in 2003 could have predicted that in 2009, electoral fraud in Iran would be exposed and a revolution catalyzed by a technology that would be invented three years hence.

In 2003, no one could predict that a transformative social network, Facebook, would be founded in 2004. How could they, in 2003, people were busy trying to figure out how to integrate the modern Blackberry (first released in 2002) into their lives. In 2003, these first Blackberry users had no idea that the incredible technology that just changed their lives would be obsoleted by YouTube (founded 2005) watching iPhone users in 2007.

Now, are you absolutely sure that the EMR you implement in your office today, tomorrow, or next week will allow you to move to the next wave of technology? Are you willing to bet the health of your patients on that?

If you can only access 68% of your data, your prognosis is not encouraging.

If you deploy OSCAR in your office, your future is bright.

2009 Award of Excellence

Congratulations to Dr. Peter Hutten-Czapski, Dr. David Price, Dr. Elizabeth Shaw, each from Ontario, and Dr. Cameron Ross, from British Columbia are in order.

These four OSCAR users are recipients of the 2009 Award of Excellence by the College of Family Physicians of Canada.

Award recipients have either performed extraordinary patient care, service to the community, humanitarian work, or service to the profession that is beyond the normal practice for family doctor.

The complete list of the 2009 Award of Excellence recipients can be found here.

Dr. David Chan at the Ontario GNU Linux Fest

Dr. David Chan will be presenting OSCAR at the Ontario GNU Linux Fest this Saturday, Oct. 24th, in Toronto.

Ontario GNU Linux Fest is the lead-off event for Toronto Open Source Week as Proclaimed by Toronto Mayor David Miller.

We hope to see you there.

E-Health and Privacy: The Right Model of Patient Information Sharing?

Canadian Bar Association Privacy Sub-Section Talk – April 15, 2009
Excerpts of Presentation by Micheal Vonn

. . . Policy being driven by technology,
and privacy seen receding in the rear-view mirror,
this is clearly the central privacy challenge of our time.

Although the study of health information systems is now its own sub-discipline in the academy, there is no public awareness of this issue, let alone public discussion. Patients, citizens, the public have been no part of these developments and are practically barred from even venturing an opinion because of a complete failure on the part of the government to provide any meaningful information at all.

Where we would hope for comprehensive, balanced information, when we have received what amounts to advertising slogans from the PR department: Viagra will save your marriage, iPods will make you groovy, and e-Health will make you safer, cheaper.

Where, exactly would the average citizen look for a foothold to enter such a non-debate?

The presentation is so relentlessly one-sided that there is essentially – and irresponsibly - no discussion of the profound risks beyond the mandatory endorsement that systems will, of course, be “privacy protective” and “secure”.

The very troubling lack of public awareness on these issues has driven a small, informal coalition of privacy-concerned organizations to try to fill the informational void on e-Health. And I’d like to share some examples of what we think it is critical for the public to understand about the profound transformation in health care that is underway through e-Health.

First, let’s get specific about what we’re talking about. “e-Health”, writ large, is a vast field and includes all kinds of technologies that are of undisputed benefit with no privacy concerns. Technology, for example, that allows specialist surgeons to remotely direct and guide surgeries being undertaken in far-off locations. Just to be clear, there is no Luddite Conspiracy trying to derail such fantastic uses of technology.

Nor are we concerned with electronic health care records per se. If my doctor records my data electronically and that data is stored on a server in her office, there is not very much of a difference between that and paper files locked in a filing cabinet. She is the guardian and custodian of that information in the same way. We have no problem with that, naturally.

The concern is centralization: vast repositories; massive, longitudinal databases of citizens’ health information, envisioned, as you know, to ultimately be accessible across the entire country.

I have looked everywhere I can think to look and waited in vain for any government, or indeed, anyone to provide compelling evidence that a vast centralization of citizens’ health data improves health care outcomes and/or saves money.

There appears to be almost no evidence to support the very elaborate promised benefits of this system.

This is a very serious point, and yet, I admit it often takes a comic turn. Like when minutes before her keynote address at a recent e-Health conference, a BC government official changed the name of her talk from “Evidence-based Innovation” to “Leveraging the Investment”. Or the researcher at another e-Health conference who I credit with inventing the term “soft but compelling evidence”; which is rather like saying “vague but definitive”. . .

As Ross Anderson, Professor of Security Engineering at Cambridge, wrote in the Feb 2008 edition of “The Economist”:

Patient data held at a GP practice may be vulnerable to security lapse on the premise, but the damage will be limited. You can have security, or functionality, or scale – you can even have any two of these. But you can’t have all three, and the government will eventually be forced to admit this. In the meantime, billions of pounds are being wasted on gigantic systems projects that usually don’t work and that place citizens’ privacy and safety at risk when they do.

Britain, in fact, has had to stop even pretending that it can safeguard patient data faced with tens of millions of records lost or compromised and just recently, the Prime Minister’s own medical data illegally accessed and given to the media. The Telegraph reports that civil servants in the UK are fired or disciplined for privacy breaches at a rate of about one per day.

All the credible, independent security experts that I am aware of say that a massive concentration of electronic health information imperils the privacy of that data. The “Honeypot Problem” was discussed recently in an article in the Guardian:

This is the recurrent problem with large databases that contain valuable data. Because they are so valuable, they attract malevolent attention of large numbers of hackers, fraudsters, criminals, even terrorists. Under sustained attack, even such sophisticated organizations as Microsoft and the Pentagon have succumbed…

… As well as the honey pot problem, there is another difficulty that applies to these vast government databases. To do their job, these databases have to be accessible to many people…. they can only work if they have thousands of access points. If the government cannot protect one laptop or one flash drive, what chance a system with over ten thousand terminals?

All of which, I suggest, is obvious.

So, let me conclude my prepared remarks by saying this. Contrary to the reports that consensus favours the development of centralized electronic health records, I quote from the Rowntree Report:

There is a developing consensus among medical practitioners that for safety, privacy and system engineering reasons, we need to go back from the shared-record model, to the traditional model of provider-specific records plus a messaging framework that will enable data to be passed from one provider to another when it is appropriate.

In other words, the system needs to be an architecture in which data is pushed from one health care provider to another. Not pulled from every health care provider into a massive database.

We are not building the right model of patient information sharing.

An eHealth Plan For $20M

Christina Blizzard of The Toronto Sun writes:

There is a strong argument that government is the wrong culture to build such IT projects. In the private sector, it's often start-ups, or companies with a bottom line to satisfy that come up with the innovation and know-how to develop these programs efficiently.

On Global's Focus Ontario last week, McCarter pointed out the project has been nine years in the works, $1 billion down the drain -- and precious little to show for it. (You can catch the show at midnight tonight or at globaltoronto.com.) McCarter said it will be a "challenge" for this province to make the 2015 deadline for getting health records on line. This province is lagging embarrassingly behind all other provinces on this.

Perhaps the government should turn to one of its own universities for help.

McMaster University announced last week that it has developed a, "comprehensive, secure, web-based and open source electronic health records system which is ready to be rolled out across Canada."

[...]

The system, called OSCAR, was developed by Dr. David Chan, an associate professor with McMaster's department of family medicine.

In a press release, Dr. David Price, chair of that department, said that 8,000 family physicians in this province who are not using electronic medical records could be on-line within the next 24 months.

The cost? $20 million. Compare that to the $1 billion the government piddled down the eHealth drain.

Well said.

The Media Starts to Figure it Out - Will the Government Soon Follow?

From Anna Paperny of the Globe and Mail

Efforts by governments in Ontario and British Columbia to drag their provinces' medical records into the 21st century haven't gone well: Both provinces are embroiled in eHealth scandals that have turned the endeavour into a political poison pill.

But the doctors behind two made-in-Canada electronic record systems designed years ago and adopted around the world insist it doesn't have to be this hard.

OSCAR, an open-source software pioneered by McMaster University's school of medicine, is being used by hundreds of doctors from Prince Edward Island to British Columbia, and many more from outside the country.

It puts patients' information on secure servers that are based in a doctor's office but can be accessed online from just about anywhere by logging on the same way one would to an online bank account. A separate sister system, MyOSCAR, lets patients access their own records online.

Clearly the discussion coming from the eHealth scandal is creating a conversation on what we want as a society, and whether or not we should allow the powers at be to decide what is right for us.

It is time for us to start thinking about this issue.

Who owns your medical information? Who do you want to maintain the stewardship of this, the most personal of your personal information? Would you like it to be kept, as it is today, in the private offices of your family doctor, or do you prefer that this information is keep in a large government run registry?

The security community is pretty clear on how it feels about governments maintaining large databases of their population's personal information ("1984" anyone?), but this isn't a decision that should be made by the security community.

Currently, you own your own personal information. Most people currently trust their family doctor to maintain their medical information on their behalf. Would you like this to change? It is your choice on how this story ends.

Ontario & BC eHealth scandals - OSCAR to the Rescue

From the Globe and Mail:

The eHealth scandals unfolding in both B.C. and Ontario can be tied by one theme: Governments can get into a "bagful of trouble" when they rush to embrace technology they don't really understand.

This week, the Ontario eHealth debacle continued to spread when the Auditor-General tied Premier Dalton McGuinty to the appointment of top officials who have resigned over untendered consulting contracts.

In British Columbia, detailed allegations of breach of trust, influence-peddling and fraud involving B.C.'s share of the federal-provincial initiative were revealed in an RCMP search warrant that names a senior government official, now retired, who headed the program. No charges have been laid.

Interestingly, the highest number of OSCAR users in Canada are in... Ontario, and British Columbia.

Coincidence? I think not. Doctors know when they are being scammed by the government.

(Ask Your Kids) Open Source Is the Future

Supporting open source software as an alternative to proprietary systems is increasing becoming a global government initiative to ensure consumer protection and customer advocacy. However, the Ontario government seems to have missed the point.

This article from the Joanne Frketich of The Hamilton Spectator identifies what is missing - the will of the patients, practitioners, and bureaucrats to force the system to change.

OSCAR is one of several electronic health systems approved by the Ministry of Health, and is used by more than 600 doctors in Ontario, Quebec and British Columbia.

It's not the most popular of the electronic health systems but it uses open source technology, making it much cheaper than others because the university doesn't make a profit.

"People can use it and it doesn't cost an arm and a leg to get it and modify it," said Kevin Leonard, a scientist with the Centre for Global eHealth Innovation at Toronto's University Health Network.

He has no doubt McMaster could deliver as promised within 24 months for around $20 million.

"It would be in the ballpark," he said. "I think that statement would be true. But the problem is, we don't have the will. Someone has to have the will."

He believes patients are going to have to get much more demanding before the government will make real progress on electronic health records.

He hopes public outrage over the ongoing eHealth scandal, which saw the province spend 10 years and $1 billion in a largely failed effort to create digital health records, will be enough to force change.

After a billion dollars of wasted money, it is no longer acceptable to hide behind the fact that they don't understand open source.

It's easy folks... Ask your kids!

Ontario - Setting the Global Standard on How Not To Spend 1 Billion Dollars

It is called a "learning opportunity", or perhaps a "teachable moment" - how not to spend one billion dollars.

The Ontario government, through arrogance and folly decided that they new best how to pick the market winners, run their own networks, decide on which technologies to approve and which to ignore. Basically, big brother knows best.

So how did that work out for you?

Typically, one would expect that business folks are best at running efficient businesses, network folks are best at running stable networks, doctors are best at practicing medicine, and public officials are good at representing their constituents. We continue to run into trouble when we start mixing up the deck.

Now, as a leading example of what not to do, other nations are noticing:

On the other hand, McMaster University has long maintained an open-source e-health record system called OSCAR, which is already in use in hundreds of clinics in the country. The technology is based on Java, MySQL, PostGreSQL, Tomcat and Linux and the estimated cost of deploying it in all of Canada’s clinics is CAD 20 million (as compared to 1 Billion already spent on eHealth Ontario).

What is most interesting is that the report is written by the Auditor-General of Ontario.

This raises once again the question of what our own National ID project (led by Nandan Nilekani) would look like. While the government should unquestionably hire contractors, willing to do the due diligence for the project, I see no alternative but to develop the solution in an open-source manner and not enslave ourselves to some code-monkey’s bad software.

Via The Indian digital government.

OSCAR Installers from 48 Countries

A few months ago, I posted that OSCAR was being installed in 35 countries. I just check the stats and this past month, people from 48 countries have looked at installing OSCAR.

Here are this past months top ten installers:

How Not To Spend 1 Billion Dollars

OSCAR, of course:

Researchers at Hamilton's McMaster University say they have devised an electronic medical records system that can be implemented by physicians across Ontario for two per cent of the money the provincial government has spent on eHealth Ontario.

The web-based program, dubbed OSCAR, organizes health records and can be set up on any computer system with a browser. It was first created in 2001, and has attracted more users each year.

Around 600 doctors across the country — including 450 family physicians in Ontario — currently use the software.

"In Ontario, there are approximately 8,000 family physicians that are not using electronic medical record systems. All these physicians could have OSCAR implemented within the next 24 months, and the cost would be less than $20 million," Dr. David Price, chair of family medicine at McMaster's medical school, said in a release.

The software is open-source, which means users are allowed access to its basic code. Users are free to add to or modify the software without fear of legal repercussions, as long they abide by the conditions of the General Public Licence, which stipulates that the program must remain open and sharable.

Because it's open-source, OSCAR is free. The costs to set it up come in the form of servers, hardware and support staff.

See the full article on the CBC website.

The Answer To the eHealth Crisis Already Exists

Some news from around Ontario concerning the latest eHealth crisis and how the government could save the taxpayers 1 billion dollars... OSCAR, of course:

The Future of Healthcare is Social

The Future of Healthcare is Social is an interesting article from Fast Company and frog design.

The article explores the ever increasing complexity of personalized health care support infrastructure, and the ubiquitous networking these devices and platforms are based upon.

At 39, Susan finds herself at the center of managing the health and wellness of her young family, her parents, and herself. While numerous tools on the market can help Susan do this, few are connected, the information they provide is confusing, and they're often so difficult to use that they cost her time--time she doesn't have.

Susan is not alone. Too many of us are too busy to be healthy--not because we lack awareness. We know what we need to do. It's finding the time to do it that's the problem. In an age of 24/7 connectivity that requires our near-constant vigilance, time feels more pressed than ever. Yet, it may be that the very technology allowing us this around-the-clock connection can transform how we manage our health.

The OSCAR Platform is a part of this future connectedness - delivering interconnected, but personally controlled tools to bring together the information that one needs in order to manage ones health.

OSCAR EMR has grown beyond a simple medical record keeping solution into a robust decision support tool which aids and simplifies patient care.

MyOSCAR delivers a personal health record that ties directly into your family physician. Furthermore, MyOSCAR is increasing delivering valuable analytics to allow the individual an opportunity to understand the intricacies of the data being presented.

MyDrugRef social networking platform has become the equivalent of an OSCAR Healthcare App Store. In the latest release, this platform shares more than just timely information, but tools and value-added applications as well.

Delivering services and tools on top of secure, liquid medical data will transform your healthcare experience. The great news is that you don't have to wait for the future to arrive - it is available today from your favourite open source healthcare platform - OSCAR.

Ontario Users Group Webcast

Webcast for the First Ontario OSCAR Users Group Meeting is also available. Please follow the following instructions to join the meetings:

(1) Demo Session for New OSCAR Users - Thursday, October 8th from 5:00pm - 9:00pm EDT

Meeting Link: https://maclive.mcmaster.ca:443/join_meeting.html?meetingId=1254844400133

(2) First Ontario OSCAR Users Group Meeting - Friday October 9th from 9:00am to 5:00pm EDT

Meeting Link: https://maclive.mcmaster.ca:443/join_meeting.html?meetingId=1254844487693

You will be required to type in your name and enter "oscar" as the password. Your name is just to identify you among the session participants. When you click the "Meeting Link" above for the first time, you may have to download a little java plug-in program (called Elluminate Live!) in order to join the meeting. You should be using a reasonably recent browser (like Firefox) running on a Mac or Windows PC. If you are really technically inclined you can possibly run it on Linux but please try this out before the meeting dates.

You can find the agenda for these meetings here.

UPDATED:
The webcast archive can be found here.

You'll need the password "oscar" to get in.

Reminder - Ontario Users Meeting - Oct 8/9th @ Mac

The OSCAR Ontario Users Group Meeting is fast approaching.

It will be an excellent opportunity to meet other OSCAR users from around Ontario and skill up on the latest OSCAR release.

The latest agenda and registration information for the OSCAR Ontario Users Meeting can be found here.

Transforming US Healthcare and its Shadow Impact on Canadian Health Information Technology (HIT)

The OSCAR community was privileged to be the sole Canadian delegation present at Harvard's 2009 HIT Platform Meeting, chaired by Kennedth Mandl and Isaac Kohane, both of Harvard Medical School, and the launch of ITdotHealth (www.ITdotHealth.org), a National Health Information Technology Forum.

The meeting focussed discussion on how to best leverage the injection of $40B of stimulus money into the $20B HIT industry was led with keynotes by Mitchell Kapor, of the Center for American Progress and the founder of Lotus, Clayton Christensen, the Robert and Jane Cizik Professor, Harvard Business School and the author of "The Innovator's Dilemma" (1997), and Regina Herzlinger, the Nancy R. McPherson Professor, Harvard Business School and the author of "Who Killed Health Care" (2007), along with the participation of the White House's CTO, Aneesh Chopra, Google's VP, Research and Special Initiatives, Alfred Spector, Microsoft Health Solutions Group's Chief Architect Sean Nolan, Cerner's VP, Medical Informatics, David McCallie and numerous industry, academic and government leaders.

One consensus of the meeting was the adoption of the open source CONNECT project (www.CONNECTOpenSource.org) as a mechanism to deliver data liquidity between various open, proprietary, and legacy systems of traditional HIT over the New Health Internet, the NHIN.

Open source infrastructure is seen as a key mechanism to enshrine consumer protection, and as such continues to enjoy significant financial and political support from the US Federal Government. One can only hope that the Canadian government takes notice and follows their lead.

A significant challenge ahead of us all is the trend towards devolving health care excellence from the anchored center of expensive hospitals, out through focussed and efficient specialized clinics targeting the roughly 20 major areas of medical concern today, beyond to empowered community clinics and family medicine practitioners and directly into the hands of the actual consumers of health services. Acceleration of these efforts is intrinsically critical to the issue of cost containment and improved effectiveness of evidence based medical science.

Properly designed, technology is a valuable tool in the support and delivery of world class medical services. However, throughout North America, the deployment of flagship Electronic Medical Record (EMR) and Personal Health Record (PHR) systems are lagging and even government and industry programs to offset the costs associated with their deployment has still left us with the lowest adoption rates of EMR infrastructure in the industrial world.

Although easily dismissed as an issue of techno-phobic medical practitioners, one is constantly reminded of the fact that doctors don't have an iPhone adoption problem, doctors have an EMR adoption problem. Thus something is clearly missing, and this continues to be the source of much discussion.

EMR/PHR solutions have started their lives as record keep tools. These tools have grown to support inter system communication, and business workflow. As such, a modern clinic with EMR tools can run efficiently and effectively in a near paperless environment. Accessing legible and timely information in the charts is as easy in the office as it is from home. Billing and administration flows easily from the click of a few buttons.

Modern systems such as Canada's leading OSCAR family, encompass additional tools to improve communications with ones patients (the MyOSCAR patient portal), and amongst the expert community of the practitioners social network (the MyDrugRef social network platform).

The major question is what will drive the next wave of EMR/PHR platforms, to change the adoption dynamic such that they become pulled into use as ubiquitously as iPhones and BlackBerrys are today.

One promising trend is towards the evolution of HIT infrastructure into a generalized platform that supports specialized and numerous plugin applications and micro utility apps. As these apps become sophisticated decision support tools, especially when they are tied into workflow systems that deliver timely point of care support (which has been shown to be incredibly effective in use), one can expect that the systems will become must have components of the modern medical practice, large and small alike.

Similarly, this new platform, supporting secure data liquidity between all creators of content, will be essential in empowering patients to take control of their own health in ways that are not possible today. Managing one health care will transform itself from something that is done to you into something you do yourself.

Exciting days lie ahead of us all indeed.

Upcoming OSCAR Events

This next period will be busy with OSCAR events in various locations:

• OSCAR will be represented at the Invitational Meeting, Health Information Technology Platform, on September 29-30, 2009 at Harvard University in Boston. At this event, we will be discussing the CHIP Platform - An "iPhone-like" Platform for Healthcare Information Technology. More information can be found here.



• McMaster University will be hosting the Ontario OSCAR Users Group Meeting this October 8 and 9, 2009, at Stonechurch Family Health Centre, Hamilton Ontario. This event will have a number of sessions for both freshman and veteran OSCAR users. Registration information can be found here.



• The third annual National OSCAR Usergroup meeting will be held from 10:00-17:00, October 30th, 2009, in Calgary at the Family Medicine Forum. The FMF is a great conference and we are really pleased that they have provided us with a venue for a full day OSCAR meeting. Information about the FMF and Hotel booking can be found here.



• There will be an OSCAR booth at the St. Paul's CME Conference, November 18-20, 2009, in Vancouver. We look forward to seeing you there. Click here for more information.

Getting Started With OSCAR - The Basics

After your decision to get an EMR, and your evaluation of the open and closed options available to you, it is time to plunge in and get started.

For new OSCAR users, you have a number of choices available to you starting with doing it yourself, or getting help.

If you want to do it yourself, you should join the OSCAR Users email list and review the installation instructions.

If you decide on getting help, you can contact one of the OSCAR Support companies.

OSCAR is very flexible and runs today in both large and small clinics. Most clinics run two servers - a main server which everyone one uses day to day, and a backup server which is used in the unlikely case of a failure in the first machine.

Since your EMR is supporting your real time business, and no one enjoys having a queue of patients piling up in their lobby, the two server configuration is very popular.

Not everyone runs their practice on two servers though. Some elect for a single server, and some run three.

In the case of running a single server, you would use OSCAR's manual backup mechanism to ensure that if you had a failure, you would not lose your data. Of course, if you only have one server and it fails, you will need to create a new OSCAR in order to put your backed-up data back into use.

An increasing number of clinics have elected to run three OSCAR servers. These clinics tend to run two servers onsite, synchronizing their data in realtime, and a third server offsite, generally synchronizing via a daily batch process.

Other than servers, you will need to get a decent and secure local network in your office (either wired or secure wireless will work with OSCAR).

High speed internet access is needed if you plan on accessing your data when you are not in your office. As OSCAR has very good security and uses encryption on all its communications, most people do leverage their internet connections so that they can access OSCAR from wherever is most convenient.

One accesses OSCAR via the web browser (e.g. Firefox, Safari, etc,...) you have on your computer. OSCAR is very efficient and so you do not have to run out and buy all new equipment in order to start. Most clinics will use their existing laptops and desktops when they first start.

Many OSCAR clinics use dedicated document scanners to get rid of the paper which arrives everyday. Most would agree that a good quality scanner, such as the Fujitsu ScanSnap s1500, is an investment worth making.

Network capable laser printers are another popular inclusion to a busy OSCAR office.

OSCAR allows you to start small and grow as needed.

Getting Started With OSCAR - The Homework

You want to deploy an EMR and you are scratching your head trying to figure out where to begin.

The first thing to do is shop around.

OSCAR is a wonderfully powerful and easy to use EMR. It is also, by far, the most cost effective solution of any available (as you know, OSCAR has $0 licensing fees). OSCAR is the only OntarioMD certified open source EMR. OSCAR is only EMR that, by design and legal license, can never lock you out of your system, nor block your access to your patient information. Forever.

However, there are other EMR options. Please check out the market leader Practice Solutions. Practice Solutions is owned by the CMA and thus you will have some level of confidence that the organization will be around for a while.

While comparing OSCAR to Practice Solutions, notice that the user interfaces on both the solutions are easy to use and based on modern architectural paradigms. Both OSCAR and Practice Solutions both offer a similar range of functionality and features and both offer support for similar governmental and technical standards.

OSCAR and Practice Solutions have dramatically different commercial and licensing models.

While shopping around, it is very important that you understand not only the day to day costs and fees, but also the legal rights that you retain for both yourself and the data that you enter into the EMR. Read the fine print. OSCAR's license agreement can be found here.

OSCAR is an open source licensed solution and is free of software bombs. Practice Solutions is not open source and does contain software bombs.

There are other EMR vendors available, and you should evaluate all of them, but chances are your choice will come down to the two market leaders: OSCAR, the #1 open source EMR in Canada, and Practice Solutions, the #1 closed source EMR in Canada.

Multi-language OSCAR

Trying out the multi-language features of OSCAR has never been easier.

Although the number of language packs included in the new OSCAR 9.06 base distribution is still small, the mechanism to perform basic language translation is reasonably easy, and trying it out is as simple as telling your web browser (easiest if you are running Firefox), that you would like to see OSCAR in another language.

Would you like to try OSCAR in French? If you are running OSCAR 9.06, all you need to do is open your Firefox preferences, go to the Content tab and under Languages, choose "French [Fr]". Now, restart your browser, point it at OSCAR and voilà!

Please let us know if you would like to volunteer to translate OSCAR to a new language. It is as simple as editing a single file and swapping out the English words for the dialect of your choice.

OSCAR vs. Practice Solutions

OSCAR and Practice Solutions have become the two must-have EMR finalists on your shortlist evaluation when making a decision on which EMR to choose in Ontario.

click to view larger

Practice Solutions and OSCAR are both government certified, standards supporting and based on modern architectural and user interface paradigms. Furthermore, both OSCAR and Practice Solutions will support either hosted or local deployment models.

From a user's perspective, the Graphical User Interface is the most important, make-it-or-break-it function within an EMR. Put simply, without a modern, freeform based data input model, your EMR will slow you down and frustrate you on a daily basis.

Luckily, both OSCAR and Practice Solutions have implemented very similar user experiences.

And so, considering both have similar certifications, support similar standards, offer equivalent functionality, and are both based on modern, user friendly interfaces, how does one decide on which EMR to deploy?

If you want to go with the EMR with the largest market share, the one owned by the Canadian Medical Association, then your choice is clear - Practice Solutions is your choice. It is not a bad choice. Practice Solutions EMR is a reasonably architected, user friendly software application. The CMA is a very large organization with many resources and significant assets.

OSCAR, on the other hand, continues to beat Practice Solutions in numerous head to head competitions. OSCAR has become the EMR of choice for practitioners that care about ease of use, cost, choice of supplier, platform flexibility, and data stewardship.

The OSCAR advantage is significant and hard to ignore.

• OSCAR costs significantly less. OSCAR is the least expensive, full featured and fully certified EMR to deploy and operate. There are no license fees. You do not have to pay annual support fees forever.


• OSCAR is open source. You own your data. No one has the right to take that data away from you.


• OSCAR is free of software bombs. You can not be locked out of your system by your vendor because you did not pay your annual maintenance fee, or whatever other reason your vendor may dream up. There are no back-doors in OSCAR. There are no super user passwords that change everyday without your knowledge or consent. Your OSCAR EMR is your EMR.


• OSCAR runs on commodity hardware. Any computer workstation that has a web browser is capable of running OSCAR. You do not need to purchase all new top of the line workstations. In most cases, your existing workstations will be just fine.


• OSCAR is open to end user modifications and enhancements. You are free to change OSCAR to meet your specific needs. You do not have to ask for permission.


• OSCAR is available from multiple sources. Whether you support your own OSCAR installation or choose from one of many OSCAR support companies, you are free to pick the supplier that satisfies your specific requirements.

OSCAR versus Practice Solutions. OSCAR gives you more of what you want and less of what you didn't know you were about to get.

Latest OSCAR Installation Instructions

For the OSCAR do-it-yourself-ers out there, we have updated the OSCAR installation guide to cover off the OSCAR v9.06 release.

The new install guide can be found here.

Of Hospitals, Health and Private Information

Much has been made in the media recently concerning the waste of taxpayers money related to the move towards Electronic Medical Records. Couple the potential for a fiscal boondoggle with the threat of a large scale privacy invasion by the government and we have much to be concerned about.

OSCAR users believe that we have the solution - freely licensed, government certified, standards based, and highly secure open source.

Vancouver Sun June 15, 2009 2:06 AM

Many doctors have grave concerns about the privacy implications of large centralized government databases containing people's detailed personal health information. Many doctors are also excited about the potential for improved patient care with the use of electronic medical records.

The United Kingdom has spent more than £13 billion centralizing patient records in government databases. It has been an acknowledged fiasco.

In a 2008 British Medical Association poll, nine out of 10 doctors said they don't trust the government with patient data security.

What can we do, instead, to gain the benefits of technology without spiralling costs and privacy violations?

In Canada, huge savings to taxpayers could be achieved with the use of the free open-source medical-record software developed at McMaster University, known as OSCAR.

In collaboration with Harvard and MIT, OSCAR has also developed MyOSCAR, an open-source personally controlled health record (PHR) that lets doctors securely "push" information like lab reports and clinical summaries from their electronic office records to a patient's PHR. The patient can log into his or her PHR from home or when seeing a specialist.

With PHRs, patients become the custodians of their key cradle-to-grave medical information.

Why are we spending millions of tax dollars on proprietary software when there is open- source software that does as much, or more? Why aren't we looking at alternatives like PHRs for the long-term storage of personal health information?

The good news is that more and more doctors have asked these questions and decided that OSCAR makes more sense.

David Chan, MD

Associate professor of family medicine and director of information technology, McMaster University, Hamilton, Ont.

Why Not Just Use OSCAR?

Today on CBC's Metro Morning radio show, Andy Barrie and Jesse Hirsh discussed the current crisis in Ontario's eHealth organization and asked the obvious question - why is the Ontario government wasting money trying to implement expensive closed proprietary systems instead of doing more to promote the free & open source OSCAR EMR.

A very good question, indeed.

OSCAR - blog en español

The international OSCAR users have become a wonderful source of pride to the OSCAR community, and so it is with great joy that we can introduce you to the blog that's been created by Dr. Santiago Dejo, a family physician in Argentina.

Please visit his blog at http://oscarcanadaes.blogspot.com and say hello.


Una gran bienvenida a nuestro nuevo OSCAR amigos y colegas en la Argentina.

New User Manual, New User Experience

OSCAR's latest user manual has gone online and has become much more interactive.


One benefit of an online manual is that Google Translate works on it.

If you would like to see the manual in Spanish for example, it is easy to make the switch:

Or perhaps OSCAR in French is more suitable for you:


We are looking for volunteers to contribute to the manual to make it even better.

If you would like to volunteer, please contact David Chan (dchan@mcmaster.ca) to get write access to the document.

OSCAR Installers from 35 Countries

In the past month, people from 35 countries have taken a look at installing OSCAR.

Below is an ordered list identifying the top ten countries from where the interest has come from:



OSCAR continues to enhance support for international users by delivering support for Internationalization in the upcoming release.

If you rummage through the source, you will see that English, French, and Portuguese modules have already been crafted. Based on the number of global users downloading and installing OSCAR, we can only guess that support for additional languages is just a matter of time.

OSCAR Grows 275% in British Columbia

We've been counting OSCAR users in British Columbia and what we've found was so exceptional that we had to check our math.

Over the last six months, the total number of known OSCAR users in British Columbia alone has jumped to 270!


This represents a 275% growth in the OSCAR user base so far this year.

OSCAR Certifies OntarioMD CMS Spec 3.0

OSCAR Canada is very happy to announce that the OSCAR EMR is now OntarioMD CMS Spec 3.0 (conditionally) certified.

OSCAR is the only open source EMR in Canada that is certified by OntarioMD. Furthermore, no other OntarioMD certified EMR solution gives you complete and unfettered access to your data, the database that it is stored in, and the source code for the solution - now and forever.

As we've discussed before, CMS Spec 3.0 certification is a major achievement in the life of the OSCAR project.

OSCAR users can be very confident that their chosen EMR continues to advance technically and in conjunction with important public standards such as those being defined by OntarioMD.

Preview: OSCAR 9.04

New Encounter window (click on it to see a larger image).

The upcoming OSCAR 9.04 has a number of new features, including time saving one-click-direct-billing-from-the-chart, and additional new CPP boxes.

Data Portability Is A Big Deal

Vendor lock-in. Dirty, despicable words. Vendor lock-down. Even worse words.

Let's say that you are writing your Master's thesis and right before you have to hand it in, your support agreement with Microsoft expires and you no longer have access to your work.

That would be bad. Very bad. So bad in fact that it doesn't happen. When you license Microsoft Office, the Microsoft Corporation can't lock you out of your stuff. After all, your work is your work.

Years after you've left university, you are practicing medicine and using the latest tools. Fantastic tools like the modern EMR.

Things in life change and perhaps you decide that you want to move to a new practice or adopt some new technology. Perhaps you are not moving, but your vendor has expired or is no longer responsive to your needs and you need move your medical records to a new system.

A lot of physicians are in this exact position today. Unfortunately, many of these physicians are having a crash course in the nuances of being, for the lack of a better word, screwed.

Before spending once minute inputing a single piece of valuable information into your EMR, ask yourself this:

Is my relationship with this vendor going to last FOREVER?

Then, look in the system for the data export feature.


This is the data export window in OSCAR.

Click a couple buttons and take your information with you.

It is that easy.

Has OSCAR Become the #2 EMR in Ontario?

We know that OSCAR is the #1 open source EMR in Canada, but how does it compare to the proprietary vendors as far as market share?

Most proprietary EMR solutions are extraordinarily expensive to operate. To encourage EMR usage, provincial governments across Canada have developed programs to fund doctors as they transition to electronic records. Because the governments are paying the bills, they have a pretty good idea of EMR market share.

Recently the Ontario government published EMR market share statistics, current for March 2009, in Ontario.


The unfortunate part of these statistics is that OntarioMD only counts the doctors that have been funded by the government, and not the actual number of doctors using an EMR.

OSCAR users have recently been counting themselves to get a sense of how large our community is. Our current understanding is that there are 438 physicians using OSCAR in Ontario.

Further analysis of the data leads to an interesting conclusion - OSCAR may now be the EMR in Ontario with the 2nd largest market share, when measured by the actual number of physicians using an EMR.


By updating the OntarioMD statistics, and swapping out funded physicians with just physicians, we find that OSCAR is catapulted into 2nd position, when measuring market share.

OSCAR Fundraising Update

From the every tireless Dr. Colleen Kirkham, an update on the current OSCAR Canada Users Society fundraising effort:

The OSCARCanada first ever fundraising campaign was launched in early March and has raised $17,500 to date. Donations have come from BC, Ontario and Quebec. A huge thank you to all those in the OSCAR community that have made a donation so far!

There is a new page on the OCUS website where donors are acknowledged. (Note-if you have made a donation and don’t see your name there, please let me know. You are likely in the group of 20 anonymous donors as I didn’t want to post anyone’s name without explicit permission to do so!)

For those of you who have been meaning to make you donation, you can find the form here. Keep those cheques coming in!

What we will do with the funds raised? David Daley has created a new roadmap page which outlines the top items we are targeting for the October release. You can also see what has been completed on the April release. Some programming we hope to accomplish includes:

We have a programmer lined up this spring to revamp billing module and the WCB module

Dr. Karen Cunnningham has collated a wish list for changes to the prescription module

At the national usergroup meeting we agreed on changes we want to the encounter page

We also have plans for a new INR module

What to do if you don’t see your most desired programming item at the top of the list?:

Start by making sure your item is on the wishlist

Be vocal, participate, show up at the meetings, teleconferences etc and make sure you are part of the ongoing discussion

Volunteer-the more people we have helping to move this project forward, the more we can get done –there is a job for everyone!

Don’t forget to make your donation –we can’t do anything without funds for programming

Don’t panic, be patient –those of us that have been using OSCAR for a few years can tell you that most things seem to get done eventually and the speed of development is actually very fast

If you really can’t wait –hire a programmer (or your kid) and get started (but don’t forget to talk to Jay Gallagher or David Chan about what you want to build!)

The OSCARCanada board of directors will be discussing the ongoing management of the wish list and the setting of priorities and how to do this in the most efficient and fair way. If you have any ideas about this, please pass them onto the board. Your board of directors are listed online and all of them read the list serv!

Thanks again to Dr. Carole White, our treasurer, who is processing all the donations.

I will keep the group posted regarding how our fund raising campaign is going.

Colleen

OSCAR EMR Roadmap

OSCAR Roadmap
(last update, April 15, 2009)

The OSCAR Roadmap strategy is to target two formal releases each year - in April and October. We've adopted a new numbering strategy consistent with other significant open source projects, specifically following the format Year.Month. The next release will be version 9.04.

Source code will continue to be available for interim and development releases.

OSCAR is based on a community based development model. Current contributors to the OSCAR project include:
- Large institutions (e.g. McMaster, McGill & City of Toronto)
- Independent companies (e.g. OSCAR support companies)
- User Groups (e.g. OSCAR Canada Users Society)
- Independent clinics and individual doctors

We encourage all users and organizations that are working on significant new features to inform us of what they are doing so that we can support and publicize their efforts.

Whenever possible, our intention is to be transparent about what features are currently committed (ie funded and scheduled), and which are currently planned (ie prioritized, but funding/scheduling is still being organized).


Spring Release - April, 2009 - OSCAR v9.04 (committed)

- OntarioMD CMS Spec v3.0 conformance, including improved data portability, chronic disease management, and diabetes reporting
- French OSCAR & improved internationalization
- OSCAR Measurements extensions to enable easier end user customization
- Improvements to the encounter page (additional CPP input boxes)
- Customizable CDM flow sheets and new CDM flow sheets for other diseases
- ICL lab interface
- support for OntarioMD web portal
- enhanced support for MyOSCAR, including
-> create patient myoscar account from the demographic screen
-> direct pasting of the myoscar message into eChart roll
- enhanced support for MyDrugRef, including
-> display/hide MyDrugRef messages while prescribing
-> show how many untrusted postings



Fall Release - October, 2009 - OSCAR v9.10 (planned, unless noted otherwise)

- (committed) Billing subsystem improvements and extensions, including BC specific improvements, multi-jurisdictional support allowing easier regional localizations
- Prescription subsystem improvements (workflow and functionality)
- Document handling and workflow routing enhancements, including scans delivered to inbox, improved document tagging
- Improvements to the allergy module (improved interactions)
- Reworked INR flow sheet
- Code maintenance, UI cleanup, improved documentation

Access OSCAR Anywhere

Walk outside.

Pull your iPhone out of your pocket.

Open up Safari and navigate to your OSCAR EMR server.

Accept your certificates & enter your passwords.

Enjoy reviewing your latest lab results while sipping a coffee, on your patio, in the summer sun.

OSCAR EMR Security

"Will my medical records be safe?" This is what is all reduces to. This is what patients are concerned about. This is what practitioners are concerned about.

Before the deployment of your EMR, you may have your medical records in locked cabinets, within a locked room, within a locked office, and within a locked building. Most, however, have their files on open shelves in a locked office, within a locked building.

In the world of paper charts, the concept of offsite access and offsite backup is usually a function of the files that you've taken home with you at the end of the day.

By computerizing your infrastructure, you will clearly gain new functionality (e.g. reviewing lab results from the Bahamas), but how does this affect the security of your medical information?

Unfortunately, all EMRs are different and thus the security of your medical records are a factor of the EMR you select and the architectural decisions made during its construction.

The good news for OSCAR users and the patients they care for is that you are in safe hands. You don't have to take our word for it. OSCAR is an open source project and as such, the security model is plainly available for anyone to look at, review, evaluate, and improve.

When you select an EMR, you should insist on reviewing or performing an independent third party security audit of their system before your entrust your records in their package. It is not acceptable to "just trust them". It is not acceptable to believe that the mechanism used to implement the security of your medical records is "a secret".

Within the security community, it is a known truism that publicly available, tested, peer-reviewed and improved security mechanisms are significantly more secure than those mechanisms that are based on the cleverness of a hidden algorithm. It is important to realize that no reputable scientist disputes this fact.

In the security world, it is what you don't know that kills you. For an example, review how Researchers Crack Medeco High-Security Locks With Plastic Keys.

It is no secret that some consumer operating systems are inherently insecure. OSCAR starts on a secure foundation. OSCAR was designed to run on the open source UNIX operating system. UNIX is a very old operating system. It was first designed in 1969 by a group of very clever folks at Bell Labs. In the 40 year history of UNIX, it has become the industrial operating system of choice due to it's flexibility, efficiency, and robust security.

OSCAR uses a number of significant open source packages, including the Apache-Tomcat web applications framework, the MySQL, PostgreSQL relational databases, SSL & PGP encryption technologies, and the JAVA programming language. Each of these open source projects were designed with security in mind, have been deployed and tested on hundreds of millions of servers around the world, and have been challenged and enhanced repeatedly over the years.

OSCAR users don't access the infrastructure directly. OSCAR runs as an unprivileged application within an overall secure environment. OSCAR users access the application, the application accesses the needed infrastructure as required.

Clearly OSCAR is based on a secure, robust and tested platform, but what about the OSCAR application itself?

Let's start with the login and take if from there.


Before you connect to the server, your web browser will encrypt the data stream between you and OSCAR. If you try to access OSCAR via an unencrypted channel, your server can be configured to reject your connection, or redirect you to the encrypted one. OSCAR can be configured to force users to supply secondary passwords to gain access from any computer, or from just those machines not physically connected to your local office network. OSCAR can be configured to allow connections only from specific computers, machines that have been authorized by OSCAR administrators in advance, whether these computers are local or remote.

Once OSCAR users log in, the security doesn't stop. What you actually see as a user is dependent on what role you've been assigned.


OSCAR comes pre-configured with specific security roles for a number of typical users:

Admin

Doctor

ER_clerk

External

Locum

Nurse

Receptionist

Remote_access

Vaccine Provider

And these roles are easily expandable to meet your specific needs.

The access rights of your users are then configurable at the object level:


This gives you incredible control over who gets to see and do what, and under which circumstances.

OSCAR has a legally relevant audit trail. What this means is that everything that anyone does in OSCAR is tracked and timestamped. If a user writes a prescription, it is tracked. If a user views a chart, it is logged.


If information is accessed and modified, not only is it logged, but the modifications are tracked so that you can view both the "before" & "after" records.



OSCAR security has been designed throughout the system, and the system was designed with security in mind.

However the best security in the world is useless if users will turn it off because it gets in the way of ease of use and simplicity of operation. Once again, OSCAR has taken this challenge up.

OSCAR users typically find that a correct balance has been achieved. Layers of security prevent unauthorized access to the system, but authorized users have full and easy access to the platform, making the day to day use of the system a joy to work with.

It is nice to know that you can count on an electronic medical record system that has been designed to give you the security that you need today and into the future.

McMaster Family Health Team Wins Award

The Ontario College of Family Physicians recently announced the 2008 Family Practices of the Year. Along with The Centre for Family Medicine Family Health Team, Kitchener, and the Victoria Family Medical Centre, London, McMaster Family Health Team, Hamilton was recognized.

The McMaster Family Health Team is one of the most advanced family practices in the country and their facility is truly an amazing operation to visit.

The McMaster Family Health Team provides care to 27,400 patients with two large primary care teams consisting of 28 physicians, 15 nurses, 6 social workers, 2 dieticians, 1 lactation consultant and numerous support staff. They also educate 64 Family Medicine residents at the two teaching sites.

Congratulations to Dr. David Chan, Dr. David Price, and the rest of the McMaster Family Health Team.

OSCAR & OntarioMD CMS v3.0

The OSCAR team has spent this last week going through OntarioMD's CMS Specification v3.0 conformance testing.

CMS Specification v3.0 introduces requirements to provide better functionality to support chronic disease management, to enhance querying and reporting capabilities within CMSs, and to connect CMSs to the comprehensive knowledge resources available on the OntarioMD.ca physician website. It also includes refinements to existing requirements to better serve the needs of the healthcare community.

The CMS Specification also prepares certified Offerings for e-Health initiatives such as the Ontario Laboratory Information System (OLIS) and the provincial Diabetes Registry.

Official results are pending, but our team is very confident about the outcome.

Once achieved, the certification as a CMS v3.0 compliant application will mark another major milestone in the life of the OSCAR open source project.

OSCAR - The #1 Open Source EMR in Canada

OSCAR users may believe it to be an obvious statement, considering the large number of clinics and doctors that rely on OSCAR everyday in support of their delivery of world class patient care, but OSCAR is the #1 open source EMR in Canada.

OSCAR powered clinics can be found across this great, multicultural land, from Prince Edward Island on the Atlantic Ocean, across 6,000 kilometers of lands and lakes to Vancouver Island on the Pacific.

There is a French version of OSCAR being developed in Quebec, and there is a Portuguese version of OSCAR that was developed in Brazil.

OSCAR EMR is spreading everyday! Recently, OSCAR has been gaining a global footprint.

To illustrate, the map below shows the global downloads of the OSCAR installation tutorial in the last couple weeks.



What this graphic shows is that on average, every day, someone in the US is reading about installing OSCAR. Every second day, someone in India and someone else Mexico is doing the same. Once a week, someone in Argentina and Austria is giving it a go.

How Much Can Open Source Save You?

As it turns out - lots! In a recent report (via Ars Technica), the Gendarmerie Nationale identified significant cost savings as a result of moving towards open source applications and platforms:

France's Gendarmerie Nationale, the country's national police force, says it has saved millions of dollars by migrating its desktop software infrastructure away from Microsoft Windows and replacing it with the Ubuntu Linux distribution.

The Gendarmerie began its transition to open source software in 2005 when it replaced Microsoft Office with OpenOffice.org across the entire organization. It gradually adopted other open source software applications, including Firefox and Thunderbird. After the launch of Windows Vista in 2006, it decided to phase out Windows and incrementally migrate to Ubuntu.

Since 2004, [...] the Gendarmerie has saved up to €50 million on licensing and maintenance costs as a result of the migration strategy.

Interestingly, the Gendarmerie noted that their migration to open source was less troublesome than the alternative:

[Gendarmerie Lieutenant-Colonel Xavier Guimard] believes that the move from Windows to Ubuntu posed fewer challenges than the organization would have faced if it had updated to Windows Vista.

"Moving from Microsoft XP to Vista would not have brought us many advantages and Microsoft said it would require training of users," said Lt. Col. Guimard. "Moving from XP to Ubuntu, however, proved very easy. The two biggest differences are the icons and the games. Games are not our priority."

OSCAR EMR users have long experienced the benefit of open source software including reduced support costs, and more robust and secure infrastructure.

myOSCAR - A Secure OSCAR EMR Adjunct For Personal Health Records

myOSCAR is a Personal Health Record solution that has the nice quality of being able to tightly integrate with the OSCAR EMR that you've deployed in your practice.

The practitioner sets the level of information to share with the patient, then the systems work securely together to keep the data synchronized, saving time and effort for both the practice and the patient.

When deployed together, the OSCAR EMR + myOSCAR PHR combination delivers an excellent platform for both improved patient care and practice management.

Upcoming OSCAR Users Event

The BC OSCAR User Group invites you to come and hear about Free / Open Source software and how physicians and midwives are driving the OSCAR (Open Source Clinical Application Resource) Electronic Medical Record in BC.

There will be a presentation by Dr David Chan, from McMaster University, OSCAR’s founder, and the OSCAR user community in BC. OSCAR users will demonstrate the EMR including use with voice recognition software, tools for maternity and newborn care, leading chronic disease management tools, prescribing tools, billing and much more!

OSCAR is an open-source (free), Canadian web-based EMR, developed and driven by its users. Users pay no licensing costs and have the freedom to choose who provides support. There are a large number of users in Ontario, British Columbia, Quebec, PEI, and recently Alberta. It has won several prestigious awards for IT innovation.

Where:

BC Women’s Hospital
Lecture theatre room D308
(Use the entrance off Heather St & 29th; enter through doors under BC Women’s Health Centre sign, proceed up one floor via elevators, and follow hallway to your right as you exit elevators.)

When:

Thursday, March 26, 2009 – 6:30 pm to 9:00pm

Cost:

Free

For more information, and to RSVP, please visit the OCUS website.

Info For New Users

There are two different types of new OSCAR users:

• those that are trying to get themselves up and running


• those that have gotten help to get up and running and are now looking to improve their skills

The Self Starter - Getting Installed

If you are trying to get yourself up and running, then you will need to install OSCAR on a UNIX server. There are instructions available for those that are technically savvy.

A second option for the self starter is to acquire OSCAR preinstalled from the OSCAR Canada Users Society.

The OSCAR server is a machine that will attach to your network and sit in a corner or a closet in your office. It is good practice to ensure your OSCAR server is powered via an Uninterruptible Power Supply (750 Volt-Amps should be adequate for a simple installation). It is also recommended to consider a robust backup strategy. Because of the nature of the system, it is quite easy to configure an automated process that provides both local and remote backups.

Typically, OSCAR is not accessed directly on the server machine, but over your local area network via the web browser of your various office computers.

If your office has internet access, then you will be able to access OSCAR from your computer at home as well. Remote access is greatly simplified when your office internet has a fixed IP address. If your office is internet enabled, then you will need to ensure that you properly review and understand your computer security.

OSCAR works with Macs, PCs, and Unix workstations (virtually any modern computer with a web browser). Some doctors configure their offices with a computer in every room, while others opt for using an ultralight laptop that they carry with them instead of the traditional paper patient chart.

If you do use your laptops and desktops with a wireless network, please purchase a modern router with the latest encryption standards, as currently all but the WPA2 AES standard have been hacked.

OSCAR will work with voice recognition software, but many doctors recommend the PC version of Dragon Voice over its Mac cousin.

OSCAR can electronically generate prescriptions and other forms and documents, so it is a good idea to have network capable laser printers available in convenient locations. Wired network printers tend to start printing quicker than their wireless brethren, so this may be a useful consideration.

Scanning documents into OSCAR is also supported. Many users recommend purchasing a dedicated departmental workgroup scanner (such as the Fujitsu ScanSnap or Visioneer Patriot).

OSCAR supports automatic electronic lab uploads from a number of different sources, and each comes with different infrastructural requirements. Gamma, for example, allows you to log into their website and download the current batch of lab files, so naturally you will need internet access for this to work. Lifelabs and CML both have a dialup modem configuration that requires a WinXP computer and a dedicated phone line. Other labs such as ICL and Excelleris have their own specialized requirements. You will need to check to see specifically what your lab needs before investing in infrastructure.

Depending on province, OSCAR may support your local billing environment. In Ontario, for example, a computer with a modem is needed to access OHIP's EDT. You can also put your billing files on a floppy disk and send it to the government, although, finding a computer with a floppy drive these days is non-trivial.

Once OSCAR is up and running, you may wish to consult with the OSCAR User Manual to help you learn the bits and bobs.


Now That You Are Up And Running

Not everyone wants to install and configure OSCAR themselves. There are a number of OSCAR support companies that are happy to deliver a soup to nuts solution, train you and your staff, and support you through your migration to electronic medical records.

Once you are installed, trained, and feeling comfortable with OSCAR, there are many ways for you to enhance your environment and engage with the OSCAR community.

You may consider joining the OSCAR Canada Users Society. The OCUS has regular meetings in various locations across Canada. The national users group is also a good place to find out more about your regional and local OSCAR communities.

A number of OSCAR users participate in lively discussions on improving their patient care and best practice strategies when using OSCAR. The easiest way to engage with other users is to join the mailing list, introduce yourself, and join the discussion. (Please note that the main national users mailing list is the oscarmcmaster-bc-users list which is linked above.)

If you are an OSCAR user with a flair for the technical details and a desire to contribute code to the project, than a second discussion list is available for you.

Many users have made available their own contributions, in the form of user installable extensions to OSCAR. By browsing the resources, you will be able to find new forms, drawing packages, report templates, and queries.

There are also resources to show you how to build your own extensions.

After you've used OSCAR for a while, you may start thinking about improvements you'd like to see in the solution. If this is the case, then the thing to do is to check and see if what you are thinking is already on the wishlist. You may also consider making a donation specifically geared towards accelerating a specific piece of functionality.

Remember, the easiest way to engage with the OSCAR community is to register with the OCUS and join the discussion.