OntarioMD Approval – OSCAR + Integrator Data Sharing

Today, the OSCAR community received the official approval from OntarioMD for the OSCAR + Integrator distributed data sharing solution. The OSCAR + Integrator solution is now fully OMD funding eligible for distributed health care teams (Configuration 1 Data Sharing).

The clear benefit of this solution is the allowance for the total EMR autonomy of each clinic, while still being able to share information electronically throughout a large group.

This certification is a very big deal.

Finally, large and small distributed health care teams have a real choice for their EMR solution. You are no longer required to support everyone in your organization via a single centralized location; each clinic can manage their own independent EMR, and the Integrator automatically and transparently handles the distribution of appropriate information from one clinic to another.

With the Integrator, each individual clinic, in conjunction with its patients, can decide how much clinical information to share throughout the larger circle of care. Extensive security and user control allows you to safely and efficiently share your entire chart, a few key components of it, or none of it at all.

For example, in a Family Heath Organization with 35 doctors spread across 20 clinics, each clinic could run an independent OSCAR EMR server (1 x EMR solution per clinic), whilst the group would deploy a single Integrator to facilitate the sharing of relevant patient information amongst the entire group (1 x Integrator solution per organization).

The OSCAR community has much to be proud of in the attainment of this certification. Our engineers leveraged the excellent work of the OSCAR and CAISI projects to deliver an exceptionally usable solution, bringing together the very best of both projects in support of large health organizations.

OSCAR on the iPad - Your Patients Thank You

Get out your iPad. Log into OSCAR. Write a prescription. Sign it electronically with your finger. Fax it from your office to the patient's favourite pharmacy.



Welcome to your new EMR.

Schedule + Caseload Management, Together at Last

Getting to your charts as quickly and efficiently as possible is what we all want, but we don't all work the same way.

Even within a single practice, your daily workflow may change over the course of the week. You may find that some days, your workload is driven by an appointment schedule, while other days, it is driven by rounds at the hospital, extended care facility, or with several house calls.

The ability to support different workflow models has long been embedded within the OSCAR and CAISI systems, but in the past you've always had to make the choice - schedule vs caseload workflow management.

Now, as a result of an extensive integration effort, you can have both workflows enabled at the same time.

So on Monday, you can visit St. Mungo's...



... Tuesday to Friday, you meet your scheduled patients in your office...



... and Saturday, you can make your rounds in the Nebuchadnezzar...



Of course, you may decide that the caseload manager isn't just for rounds, but may be useful for tracking and grouping specific patients that may be of particular interest to you. Perhaps they are part of a clinical trial, being managed by a resident, or are recently recovering from a procedure.

You know your patients the best. OSCAR gives you the tools to care for them more efficiently.

Distributing Data – A Better Sharing Model for OSCAR

The Integrator is the CAISI designed, multi site, ethical, data sharing engine, developed and deployed as part of the joint efforts of Seaton House, St. Michael’s Hospital, and the City of Toronto.

The Integrator provides a mechanism to share when appropriate, information contained within your EMR to affiliated sites, without the need for your entire group to be hosted off the same centralized hardware. Each site maintains an independent and autonomous EMR within its own clinic, and users still benefit from the opportunity to securely see and share records amongst a larger, geographically distributed, circle of care.

This distributed model of data sharing tends to be more robust than the centralized approach, due to its inherent redundancy, and lack of any single points of failure.

Recently, a significant amount of work has been expended to extend the capabilities of the Integrator such that it could work seamlessly and natively with OSCAR based clinics. This work has further integrated the CAISI and OSCAR solutions, such that it is easy to dynamically move between scheduled and caseload based workflows for your practice.

Now, users of OSCAR, can extend their reach to a much larger circle of care, whilst maintaining their independence and autonomy within their specific clinic.

The Integrator gives you a data sharing model that is easily and granularly configured on a per clinic basis.

Integrator’s ethical consent to data sharing is very easy to manage, as it gives the patient the option to opt in and out data sharing amongst facilities, on an as needed basis. It also gives the participating clinic an appropriate level of audit trail for these consents.

OSCAR, enhanced with CAISI caseload management and augmented with Integrator data sharing is truly an exceptional platform. It is no wonder why OSCAR is now on everyone’s shortlist when they are choosing a new EMR.

National OSCAR User's Group Meeting

The 4th annual national OSCAR Usergroup meeting will be held at the Vancouver Convention Centre, on October 16th, in association with the 2010 Family Medicine Forum.

This all day event will include numerous presentations and demonstrations by the OSCAR community, for the OSCAR community.

To attend the OSCAR meeting, you will need to also register for the FMF conference.

If you would like to attend the OSCAR meeting, please let us know by jotting down your details via our registration form.

What a Year for OSCAR - Now #3 in Ontario

OSCAR has become the #3 EMR in Ontario within the new OntarioMD funding program.

OSCAR has 14.5% market share of newly funded users, just behind Healthscreen's 20.3% and Practice Solutions' 23.5%.

Ontario's New EMR Adoption Program (832 funded physicians from October 2009 to August 31, 2010):

This is a massive increase of new users in Ontario compared to the previous funding program, which OSCAR achieved a 3.4% share of the funded market, and a total overall ranking of #8.

Queen's Gets OSCARized

We are very happy to welcome to the OSCAR community Queen's Family Health Team, Department of Family Medicine, Queen's University.

If you visited one of their four clinics this week,  you may have noticed the staff a little more wide-eyed than normal.

Queen's has been using an EMR for many years, and so the conversion from their old system to OSCAR has been quite an activity. Countless hours of preparation and planning have gone into making the transition as seamless as possible.

At 8:30 on June 7th the first patients were being seen. Soon thereafter, records were being entered, results were being reviewed, forms and requisitions where being filled, and the first prescriptions were being electronically signed and faxed to the local pharmacies. 

A collection of clinics with well over 100 users needs some reasonable hardware to run their practice. Queen's primary server has dual quad core hyper threaded Xeon CPUs coupled with a non trivial amount of memory.

EMR conversions are pretty intensive operations. Tens of thousands of medical records have to be meticulously moved and reviewed to ensure data integrity and patient information is maintained.

Throughout the process is important to maintain good sense of humour and to remember why you decided to move to a new EMR in the first place.

Thank you Queen's for to moving to OSCAR. 

Transforming your Patient Engagement: OSCAR on the iPad

Say goodbye to that "third person" in your examining rooms.

OSCAR is the only Ontario Certified EMR platform that runs on the Apple iPad. This fact is true because OSCAR is a standards based web application that has not been hardwired into a specific operating system or web browser.

OSCAR clinicians today are currently experiencing the joys of engaging their patients using the unobtrusive iPad technology. Early feedback has been extremely encouraging, although there are still some issues to work through (native printing within the iPad is not currently supported, however, there is an app for that).

iPad and iPad-like technology will revolutionize your engagement with your patients and, if you are an OSCAR user, you are already good to go.

OSCAR users - isn't it nice to know that you picked the right solution, one that was mindful of the pervasive transformative technology trends? Congratulations.

(Yes - this is a big deal)

BC Oscar User Group Meeting, April 19, 2010

Shelter Lee has posted videos from the recent BC Oscar User Group Meeting.

The first one is here and the rest can be viewed at http://www.youtube.com/view_play_list?p=310FF13164E7AB03.

Recognizing the OSCAR Community

One of the major reasons that people choose OSCAR is our vibrant and extensive community of users and supporters.

When we get together, as we did recently in Vancouver, for a user's group meeting, it has become customary to hand out a few OSCARs in recognition to the exceptional contribution of specific individuals to the OSCAR ecosystem.

This year's recipients are as worthy a bunch of OSCAR as ever.

Awards were received by:

• Randy Jonasz- Developer of the year
• Trudy Chiswell -Longstanding contribution to the OSCAR community
• Shelter Lee-Best volunteer developer
• Gunther Klein (“super G”)-OSCAR volunteer of the year
• Gianna Tanner -OSCAR Goddess( MOA of the year)
• Best New Practice -Highland Medical Practice of Comox, BC.
• Tomislav Svoboda-OSCAR Achievement Award
• Gordon Hutchinson –Best New user
• David Page - OSCAR user of the year
• Patti Rodger Kirkpatrick and Claire Dickson share the- OSCAR volunteer of the year award

Congratulations to all. 


For more details about the award winners, you can see the full post on the OSCAR Canada website.

OSCAR Open Source Electronic Medical Record Demonstration

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 EMR, developed by a collaborative community of programmers and users. Users pay no licensing costs and have the freedom to choose from a range of support companies. There are over a thousand OSCAR users and over a million patients on the system nationally, and it has won several prestigious awards for IT innovation. It’s ease of use, excellence in programming, high level of functionality, and low costs for ongoing support and implementation, are part of why OSCAR is experiencing rapid growth.

For more information visit http://www.oscarcanada.org/

Where:
Paetzold Auditorium VGH,
Jim Patterson Pavilion on the 1st floor
(Parking is available at 2775 Laurel St, between 11th and 12th)

When:
Monday, April 19, 2010 – 6:30 pm to 9:00pm

Cost:
Free


RSVP :
http://tinyurl.com/ydyfebe

Upcoming OSCAR Users Event - Vancouver General Hospital, Apr. 19-20, 2010

You are invided to the next BC OSCAR User Group Meeting: Monday April 19th and Tuesday April 20, 2010. The event will be held at in Vancouver at the Paetzold Auditorium at Vancouver General Hospital.

The agenda for the BC OSCAR user group meeting is available here and includes many interactive sessions for learning more about OSCAR and sharing experiences with other OSCAR users.

Please register to reserve your space.

Government As A Platform

The folks at O'Reilly have been talking a lot lately about the massive effort currently underway in the US to modernize the Heath IT infrastructure.

A number of posts are of particular interest to those people trying to figure out how to pull information together from so many different systems.

First, Tim O'Reilly discusses the emerging trend towards "government as a platform", that is, the government taking the role of defining what needs to be shared and what needs to be connected, but not actually getting involved with the specific implementation or hosting of the systems. O'Reilly uses the example of the Office of the National Coordinator, to illustrate:

There is also substantial funding for Blumenthal's office, the Office of the National Coordinator, or ONC. (This office was created by the Bush administration, but didn't receive substantial funding prior to the Recovery Act.) But rather than building a massive, centralized system for electronic health records, ONC's goal is to define the rules of the road for interchange of patient records. In internet-style, the expectation is that common protocols and file formats will allow vendors to compete on a level playing field to build the actual applications. But they aren't just writing paper standards; they are creating building blocks that actually implement those standards. (The internet analogy would be software like Bind, which implements the DNS protocol, and the root domain name servers, which for many years were funded by the US government.)

Also worth reading is Andy Oram's May 3rd report on the HIMSS Heath IT conference. Andy talks about the technology of openness and interoperability in a land of highly mobile people:

The U.S. has a mobile population, bringing their aches and pains to a plethora of institutions and small providers. That's why health care needs interoperability. Furthermore, despite superb medical research, we desperately need to share more information and crunch it in creative new ways. That's why health care needs openness.

 Oram covers what technology has been done and how it is fairing, and what still needs to be addressed and how different organizations are approaching the challenges. Of particular interest is the section on open source health projects such as Vista, OpenMRS, and CONNECT:

CONNECT is championed by the same Office of the National Coordinator for Health Information Technology that is implementing the HITECH recovery plan and meaningful use. A means for authenticating requests and sending patient data between providers, CONNECT may well be emerging as the HIE solution for our age. But it has some maturing to do as well. It uses a SOAP-based protocol that requires knowledge of typical SOA-based technologies such as SAML.

Two free software companies that have entered the field to make installing CONNECT easier are Axial Exchange, which creates open source libraries and tools to work with the system, and the Mirth Corporation. Jon Teichrow of Mirth told me how a typical CONNECT setup at a rural hospital took just a week to complete, and can run for the cost of just a couple hours of support time per week. The complexities of handling CONNECT that make so many people tremulous, he said, were actually much easier for Mirth than the more typical problem of interpreting the hospital's idiosyncratic data formats.

Just last week, the government announced a simpler interface to the NHIN called NHIN Direct. Hopefully, this will bring in a new level of providers who couldn't afford the costs of negotiating with CONNECT.

CONNECT has certainly built up an active community. One participant, who is responsible for a good deal of the testing of CONNECT, tells me that participation in development, testing, and online discussion is intense, and that two people were recently approved as committers without being associated with any company or government agency officially affiliated with CONNECT.

There is a lot to information to digest in these two posts from O'Reilly, but well worth the time.

Privacy and Regulation

Jennifer Stoddart, the Privacy Commissioner of Canada, recently gave a must-read speech on "The Future of Privacy Regulation" at the 11th Annual Privacy and Security Conference.

Very well stated is the daunting task that is facing regulators worldwide:

Of the many challenges we face, none is more dramatic than the impact of technology.

First and foremost, there is the sheer scope of the Internet, and the myriad ways in which we can now interact, shop, learn, and pretty much live online.

There’s also the staggering growth of computer capacity, which allows massive amounts of personal information to be collected, manipulated and shared.

Much of the content swirling through this Web 2.0 world is also generated by individuals, which poses new challenges for regulators.

From a privacy perspective, one consequence of these developments is that personal information can live on in cyberspace, pretty much in perpetuity. And so a typical data breach may no longer affect just a handful of people, but potentially hundreds of thousands of them.

Another consequence is that our lives have become open books. Even if we don’t advertise our whereabouts on Google Latitude, surveillance cameras and GPS-enabled cellphones are able to capture our movements.

Even if we don’t broadcast our latest purchases on Blippy.com, our online browsing habits are being quietly monitored and mined for their value to merchants and marketers.

And concepts of consumer knowledge – never mind consent – are become increasingly strained.

Of particular interest in the medical field is the simple assertion "[...] a typical data breach may no longer affect just a handful of people, but potentially hundreds of thousands of them."

If the risk of a data breach in a large centralized system is measured in hundreds of thousands, if not millions of confidential records, then one must ask, is the risk worth it?

One can not compare the lost of your famous "secret chicken recipe" due to a privacy breach on Facebook, to the damage associated with the lost of your most confidential information, which is currently known only by yourself and your healthcare provider.

When your medical records are located in the local office of a health professional, the risk of a data breach is similar whether a practitioner manages your records on paper or within the confines of a secure EMR platform.

However, it is clear now that any time a massive store of interesting data is centralized into a single location, is is much like painting concentric circles in bright red paint on the side of your web address. 

The risk to your specific privacy and, as a healthcare provider, the privacy of your patients is greatly affected by where your information is stored.

The OSCAR iPad Experience

Apple has just announced it's new iPad tablet and the technology community is reacting fast to this upcoming platform.

The Apple iPad via Apple

Windows based tablet devices have been around for ages, and now a new generation of devices are being reinvigorated from beneath the shadow of the Apple announcement.

HP Tablet via Gizmodo

The most promising of the new batch of iPad competitors are following a similar architectural strategy as Apple. Numerous vendors are showing tablet prototypes based on Google's Android mobile phone operating system.

Archos Android based tablet via Dance with Shadows

Furthermore, software houses are quickly moving to show that their wares will be compatible with the iPad. One very interesting announcement has come from Citrix, which has shown Windows 7 running via Citrix on top of the new iPad software simulator.

The Citrix Blog via Gizmodo

Of course it is too early to tell how well Windows or any other application will run on the iPad, as the devices just don't exist and outside of a few folks at Apple, very few people have actually had an opportunity to put one through its paces.

The iPad's operating system is based on the iPhone and it runs the same Safari browser as the iPhone. The iPad though, has a 9.7" screen which is capable of running at 1024 x 768 pixel resolution. (Only a few short years ago, this was the standard screen resolution of all computer monitors.)

To get a sense of what an image of that size looks like compared to your current monitor, click on and expand the below image which is a picture of the OSCAR Schedule, set to the 1024 x 768 dimensions. Now, from corner to corner, squish or stretch the image until you measure 9.7" and you'll have a rough sense of what size the iPad is, and what an unmodified version of OSCAR would feel like, running via the iPad Safari browser.

1024 x 768 pixel resolution image of the OSCAR Schedule (click to enlarge)

Many in the health care industry are very excited about the potential of using the iPad for not just unmodified access to existing applications, but also with purpose built, tablet centric tools.

We've long noted that doctors don't have technology adoption problems (as demonstrated by the wide use of iPhones and Blackberrys within the medical community), just issues with the value proposition of the existing medical IT technologies (as demonstrated by the weak market adoption rates in North America of the current batch of EMR/EHR platforms).

When it comes to health care, technology such as the iPad definitely seems, at least at this early stage, to have the potential to excite medical practitioners in a way that will deliver transformative change to the way one runs ones practice.

We don't have long to wait to see if this new technology will actually work.

In June, the first batch of OSCAR users will be firing up their freshly delivered iPads and pointing it at their OSCAR servers.

Minutes afterwards, the OSCAR iPad Experience will be christened.

iPhone EMR Apps

There is a very interesting post on the 3G Doctor blog which gives a quick look at the user interfaces of a wide range of fledgling iPhone EMR applications.

I'm impressed at the sheer number of the applications that have been purpose built for the iPhone. Definitely a space to watch.

Updated OntarioMD Funding Terms and Conditions

OntarioMD has updated the terms and conditions for New EMR Adopters, now allowing unaffiliated solo and duo practitioners funded access to OntarioMD Certified Local EMR Products such as OSCAR.

The new T's&C's, dated Jan. 5, 2010, now offer new choices for implementation:

1) a certified ASP EMR solution and use it as per ASP EMR Vendor’s and OntarioMD’s best practices, including: 

  [...]

OR,

2) a certified Local EMR solution hosted at a Participating Physician’s office and either:

2a) Join and maintain membership in and participate fully in the Vendor Collaborative Network (“VCN”) for the chosen Local EMR, and as per the VCN’s and OntarioMD’s best practices, including:

  [...]

2b) Sign OntarioMD’s EMR System Management Independent Undertaking, which includes undertaking the following as per industry and OntarioMD best practices: 

  [...] 

These changes to the OMD EMR funding program terms and conditions reflect a positive enhancement for many solo/duo practitioners across Ontario.

Of OSCAR, iPhones And iSlates

This is what OSCAR looks like when running on an iPhone.

I've used my iPhone a number of times to access OSCAR in a pinch, when I needed access to the EMR but was nowhere near a regular computer, or a regular internet.

In a pinch, OSCAR works fine on the iPhone, or any other one of these new breed of smart-phones-with-a-proper-web-browser-and-a-relatively-decent-mobile-internet-connection.

However, a pocket sized handheld computer is not a device for everyday EMR usage.

As we enter a new decade, a new class of device is being brought to market by a number of vendors. This device, a notepad sized smart phone-like device called a tablet, will soon be everywhere.

Although numerous devices are already available for purchase today, the most anticipated of these machines is an unannounced product from Apple, thought to be called the "iSlate" or "iTablet".

(image: Gizmodo)

The form factor of this new class of machine offers a similar experience to that of a smart phone, but with a larger and more spacious screen, much like a sheet of paper.

This type of computer has the potential to be particularly suited to the healthcare industry, and may end up being the specific catalyst which drives EMR adoptions throughout North America.

Welcome to 2010

Our very best wishes for a healthy and prosperous New Year.

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.