Canada Invests in EMR

The Government of Canada announced in today's budget an investment in EMR infrastructure:

Budget 2009 provides Canada Health Infoway with $500 million to support the goal of having 50 per cent of Canadians with an electronic health record by 2010. In addition, this funding will be used to speed up the implementation of electronic medical record systems for physicians and integrated points of service for hospitals, pharmacies, community care facilities and patients. An electronic medical record system allows doctors and other health care providers to chart patient health information using a computer, thereby avoiding duplication of testing and helping to ensure patient safety and effective treatment.

In Ontario, there are approximately 11,000 doctors currently not using an EMR. Will this new federal investment make a difference in Ontario and across the country?

Let's examine the challenges you are faced with when looking at the deployment of an EMR platform.

The first challenge any physician has regarding the deployment of an EMR is support. A Family Practice is a real time endeavour. If your system goes down, then so does your practice. If your practice halts, then the queue in the lobby becomes a mob quite quickly.

Thus it is critical to consider the selection of your real time infrastructure in conjunction with a plan for real time, professional support and an action plan to handle any unforeseen emergencies. Furthermore, your practice doesn't run on banker's hours, so your support team must not either.

The second challenge you are confronted with when considering the choice of an EMR is cost. Given a limited budget, where is the most benefit being derived. Will your budget be consumed solely by software licenses and expensive hardware, or will your budget be directed at providing you and your staff the training and support that will ensure a seamless transition and an enhanced environment for patient care.

The third challenging decision you must make when selecting your EMR is whether or not the ownership of your data is important to you. The medical profession is filled with stories of vendor lock-in and data lock-down. Some doctors have found that when they don't pay their annual support fee, their software locks them out, or they no longer have access to the tools and utilities required to extract their data.

Many doctors feel strongly that the information they manage must remain under their control. In this case, it is critical that the system you select is licensed open, not licensed closed.

How does OSCAR compare, considering these criteria?

A number of commercial support companies compete to deliver OSCAR solutions, training and support. This means that you have a real choice of support contract, you have an extensive range of service options to choose from, and the ability to move from one support organization to another if you are not satisfied.

Since OSCAR runs on inexpensive, commodity hardware and is freely and openly licensed, your budget is mainly directed at the requisite support and training, thus giving you a direct and tangible benefit for each dollar spent.

Finally, OSCAR source code is available and published on the internet. This means implicitly that you can never be locked out of your system. Your data can never be shut down or hidden away. You data can not be held hostage.

OSCAR has become a leading EMR choice in Canada because of how well it compares to the alternatives.

Customizing a Closed System

One of the challenges that all professionals face, is the decision to customize ones environment, to tailor your technology specifically to your own needs.

It is not uncommon to be faced, on occasion, with a situation whereas you need the ability to do something special. Perhaps, for example, you have a particularly useful application on your mobile device and you would like it integrated into your EMR.

In the world of closed systems, your problem is immense.

Even if you are willing to significantly pay for your application to be integrated, you may find that you are out of luck because the effort to deliver your custom solution may not met the needs nor the strategic direction of the corporation behind your closed system.

Barriers such have these have become so commonplace in our everyday lives, that we tend to just accept that we can't get what we want, and even when we are willing to pay, sometimes it is impossible to get what we need.

OSCAR is different. As a fully open platform, it is your it change, to enhance, to modify, and to customize.

Of course, you don't have to and may never need to make changes to your OSCAR installation. As a mature platform, OSCAR is ready to use, straight out of the box. But, it's nice to know that you can.

OSCAR - Your Data is Yours

Before purchasing a proprietary EMR solution, ask your vendor if you will require a special password in order to extract, into a generic format, your full and complete demographic and medical record data.

Ask that vendor if that special password changes on a regular basis, thus requiring you to maintain a monthly support contract with them in perpetuity.

Then ask yourself if this level of vendor lockdown is what you really want.

OSCAR is a fully open platform. Your data is, and always will remain to be, your data.

All of America's Medical Records

To improve the quality of our health care while lowering its cost, we will make the immediate investments necessary to ensure that within five years, all of America’s medical records are computerized. This will cut waste, eliminate red tape, and reduce the need to repeat expensive medical tests. But it just won’t save billions of dollars and thousands of jobs – it will save lives by reducing the deadly but preventable medical errors that pervade our health care system.

excerpt from Remarks of President-Elect Barack Obama, As Prepared for Delivery, American Recovery and Reinvestment,
Thursday, January 8, 2009

Canada and the United States have stood alone on the world stage, lagging behind with our dismal adoption of computerized health care records.

Now that one of the top priorities of the new US administration is the computerization of all medical records, will Canada still resist medical technology?

Ask OSCAR Anything

OSCAR provides an extensible interface that gives you the ability to ask the system anything and it will tell you what it knows. More importantly, this interface allows you to format the answer in a way that can be easily exported to another package.

For example, perhaps you wish to send a newsletter to your active patients.

Wouldn't it be nice if you could ask OSCAR to export the relevant demographic information to a spreadsheet so that you could print labels and form letters for the mailing?

This task is easily accomplished using OSCAR's Report By Template feature.

First, construct your query and save it as a text file on your laptop/desktop computer. (You can cut and paste the following query into a file if you wish to give it a try.)

<report title="Newletter Report"
    description="Reports Patient Addresses -
    Active, Letter Only" active="1">
    <query>
        select last_name, first_name, address,
        city, province, postal
        from demographic
        where provider_no = {provider_no}
        and patient_status = 'AC'
        and newsletter = 'Paper'
        order by last_name, address
    </query>
    <param id="provider_no" type="list"
        description="Provider Number">
       <param-query>select provider_no,
            CONCAT(last_name, ', ', first_name,
            ' (', provider_no, ')')
            from provider
            order by last_name;
        </param-query>
    </param>
</report>

Second, load your query into OSCAR, via the Admin->Report By Template window.

The third and final step is to click on the report to run it.

This particular query asks OSCAR to find all active tagged patients for a specific provider, patients that have had their Newsletter field set to paper, and when it finds them, to output a list of their names and addresses, sorted on their last name and their address.

The results can then be viewed, printed, or easily exported to another format.

Many more examples of report templates can be found on the OSCAR Canada website.

Getting Started With Building Your Own E-Forms

One of the significant benefits of OSCAR is your ability to freely extend OSCAR and make it your own.

To extend a proprietary system with a custom form typically costs thousands of dollars and plenty of time. If you do spend the money and pay for a custom form, typically, you won't own the license on the form you paid for, and thus you can't share it with a colleague who might also want use of the same form.

OSCAR contains a number of programatic interfaces and template examples which allows the end user an opportunity to extend the system with additional forms. These extensions can be made using simple web design paradigms which are easy to learn.

For example, if you wish to create a form that has a check box on it, you would use a command such as:

<div style="position: absolute; left:90px; top:30px;">
    <input type="checkbox" name="thischeckbox1">
</div>

If you wish to create a form that has a text input box, then the command is similar to:

<div style="position: absolute; left:90px; top:50px;">
    <textarea class="noborder"
        name="thistextbox2"
        style="height: 83px; width: 289px;"
        tabindex="2"></textarea>
</div>

OSCAR users have created an excellent tutorial to get you started with building your own forms. This tutorial can be found on the OSCAR Canada Users Society website.