Saturday, December 3, 2016

Is the open source nature of OSCAR dying?

A recent letter has been circulating:


And I quote the letter here:


I am concerned about the future of Oscar. There are a few recent issues which everyone who cares about Oscar should be aware of...
1) Back in April 2016, Oscar-EMR was 'reorganized', but apart from the people at Oscar EMR and the new people who have taken over, no news has been released.
I was told that a news release would be coming soon, but it has now been over 2 months with nothing.

For better or worse, Oscar EMR was made into an important piece of the community and their decisions affects all of us. Now that radical changes are happening, the community is being completely ignored.
2) MyOscar development has been directed into a new MyOscar3, which is now called Kindred PHR and is a complete re-architecture of MyOscar.
At the last FMF meeting, I was told that the new pricing structure was $10 per month per physician and free for patients and administrators.
Now, after migrating a client from MyOscar2 to Kindred, we find out that the rates are $50 per FTE per month. Reading the fine print, it also says that membership is for "a trial period" with no indication of what it may cost in the the future.
At this point, the original myoscar code is available but not being developed and the KindredPHR code is not available at all.  So much for Open Source.
3) The Annual BC User Group meeting has been cancelled, as well as our presence at the upcoming FMF. I understand that these meetings take time and planning, but there should be enough people in the community to help organize these events.
4) I saved the best for last. The McMaster Legal Department has asked some OSPs to cease using the 'Oscar' name unless they become members of 'Oscar EMR'.
How much? No prices are listed publicly and the only known members are the larger Oscar EMR 'Charter OSPs'.


My take:
Essentially, Oscar EMR has been taken over by a group of OSPs who are now preventing other OSPs from using the word 'Oscar'.
Before making any more assumptions, I think the community should be made aware of the changes and key decisions being made without their knowledge.
The entire reason why Oscar was made as an Open Source project was to prevent it from being hijacked by anyone or any group.
Now, Oscar EMR, with the help of McMaster, are taking control of the Oscar name and threatening legal action and fines if a non-approved member uses the word 'Oscar'...
Where is OCUS? Why is there no public response to these radical changes?


So - bottom line: IS OSCAR NO LONGER GOING TO BE "OPEN SOURCE"?


END QUOTE (of the letter)



My take:

It all depends upon how you define "open source".

I have little doubt that there are highly tech-savvy OSCAR users out there that will defend to the death that OSCAR remains open source.

But I'm just a Physician user who wants a rock solid EMR that won't go out of business and which won't hold me hostage for "upgrades or else....", etc.

OSCAR pretty much delivers on what I want out of an EMR, but quite frankly - development of OSCAR appears to have progressed towards numerous iterations of OSCAR across the country.  My own installation is an odd mix of BC's OSCAR and Ontario's OSCAR.....with an Alberta Billing/Lab module strapped on for good measure (it is the best in the business, so I'm happy with it).

While OSCAR is working well for me for now - I am painfully aware that it is not evolving from the perspective of an unsophisticated user.

Sure, OSCAR development has "released" new versions of OSCAR (I think that they are at version 16 now) - but few users are installing it because the "debugging" process is still suffering from an undisciplined and informal approach that leaves new versions of OSCAR potentially risky for a mission critical office tool.

I am already at a point with OSCAR that lots of its functionality is just not working on my installation.    Simply being able to enter immunizations for HepA/HepB or Gardasil, for example, are just not possible (you have to enter them as "custom" vaccinations), and this has not improved since 2009.   I could go on....

One would have thought that things like this would have been improved within 7 years, but that does not seem to be the case.  Perhaps these items are improved in the latest version of OSCAR - but it is insufficiently tested to the point that it is not worth the risk of installing it  - at least to me.  For now.

Having said this, I am aware that some installations of OSCAR in BC and OSCAR in Ontario appear to have fixed the parts of OSCAR that they don't like.  There are therefore at least TWO forks of OSCAR that I am aware of.

My OSCAR installation is potentially third fork!

Hopefully, the concerns I have addressed above will eventually be addressed - but I'm not holding my breath.  I am therefore going to consider looking at alternatives.  It kills, me - but I can't afford not to.....



I shall report back -  I don't think that any better solutions exist......most other EMR's in Canada really suck compared to OSCAR.....but stay tuned!  And wish me luck!













Monday, August 29, 2016

A slight divergence to talk about how I use OSCAR and my thoughts on Technology.....



I tend to be an early adopter of new technology.  I always like to personally assess technology to see if it can be incorporated into my life or my office to make life easier.  Sometimes it works - and sometimes it doesn't.

It is ALWAYS fun to try, though.

In terms of how to better use OSCAR, I have found that the single BEST way to use it is through a wireless network on a Macbook Air.  It just works.

I DID try to use a Yoga 2 Pro, running the new Windows 10 - just to keep up with the world of windows.....it was a miserable experience.  It mostly worked - but it just wasn't slick, and ended up wasting a LOT of valuable time.

I'm not a Mac evangelist by any means....I just value my time, and Windows 10 wasted a lot of it.

I suspect that windows users would never really notice how terrible their computer experience is until they try a Mac for a week to accomplish the same tasks.



Very, very few would be willing to go back to anything windows.



But I digress:  The Macbook Air is "the" way to use OSCAR in the office.  It is small an unobtrusive, and lets you dictate or type or use "text-expander" to take notes while the patient is talking to you.  There is an art to doing this unobtrusively - and I am still trying to improve my technique.....but I would say that most patients now don't think that they computer is "in the way".


Most importantly, you can close the clamshell of a Mac to walk to the next patient room....then open it in the next room....and you are back in business immediately with no delay.

Try doing that on a Windows machine!  NEVER works smoothly, and often logs you out.  Wastes a LOT of time.



Another thing I have recently tried, is to use my new iPad Pro.  Natively, it just "mostly" works....but for "mission critical" work like this, "mostly" is far from the mark.  So I thought that this was a "no go".....until I gave Parallels a try.



Parallels Access allows you to use the iPad Pro as a remote control for a desktop or laptop upon which you are using OSCAR.  This basically lets you turn your iPad into a desktop upon which you can run OSCAR, and it will print prescriptions, email, take voice dictation input or pen input, etc. without even a tiny stutter in performance.

It is so good that I may just no longer bother carrying my Macbook Air with me from room to room anymore.

I can also run neat apps on my iPad, like Essential Anatomy: this lets me show patients in "peel away" views, exactly which muscle is the problem with, for example, "Piriformis Syndrome", etc.



Overall, the implementation of these very nice "off the shelf" technological levers has been very beneficial to delivering the "medical care experience" in the office.  Patients feel included and well-informed.

Someone once said to me that patients take home about 10% of what you tell them, but they will remember 75% of what they see and 200% of what they feel.  We therefore take great pains to let them know that we actually care about them in this increasing "race to the bottom" our Politicians are forcing upon us to service the myth of "universal health care".

This iPad app allows patients to help to "see" what is going on with the various mechanical issues that can go wrong with a body.



So - where have I failed in my zeal to try technology in the real world?




The Apple Watch:  it has the "cool" factor for about a day, and then you fantasize about hurling it off a bridge.

I don't say this lightly.  I LOVE technology, and I love to see where it can fit into my life and work.  But the Apple Watch is FAR too ahead of its time.

The bottom line?  The Apple watch DOES NOT WORK.

It can't even tell time without a lot of fuss and bother.

Technically, the little accelerometers inside the Apple Watch, calculate according to a fuzzy logic algorithm, whether or not you just did a wrist flick to tell the time....or whether you just decided to "talk with your hands because you're a little bit Italian".  It gets it right about 90% of the time.

And THAT's the kicker.  A watch that is less than 100% reliable is a fail, no matter HOW you try to excuse it.  And all the cool little apps that you can buy for it?  They don't work (bottom line).  Sure, you can tap the face of your Apple Watch to open an App.....but then you need to go for a coffee, have lunch with your wife, see 10 patients, etc. before you can actually interact with the app.

Yes, I'm exaggerating (a bit).  But it takes at least 20-30 seconds for many (or most) of the apps to open and to start working.  This makes them 100% useless.

Oh - and try to take a pulse for 30 seconds with the Apple watch!  The screen turns off in 6 seconds.  You can probably modify this in the settings - but then your watch will stop working in a few hours because of lack of power.

Oh - and you CANNOT use an Apple Watch if you are a Physician.  Evidently, nobody in Cupertino has ever worked more than 8 hours in a day (or less if you count the 10 daily breaks for Latte's).  If you work a 24 hour call day, you have no hope of having your Apple Watch make it through with you.

You MUST charge the Apple watch for hours every night or it will simply cease to function.

I have concluded that the ONLY purposes of an Apple Watch are to

1) Save its own battery at the cost of literally everything else.
2) Make you worry about saving its battery at the cost of everything else.

I danced out of the Starbucks to the dismay of its caffeine-addled occupants after having sold my Apple Watch for the price of $800 (I paid $1200) to the "lucky dude" who made the offer on Kijiji.

Back to my old reliable mechanical, self-winding, waterproof to 300m, shock and freeze-resistant, with a second hand that never stops "normal" analog watch that I will never take off again.


And if anybody even THINKS of making an OSCAR App for the Apple Watch........







Tuesday, November 17, 2015

How to get OSCAR in Alberta

I have been asked a couple of times about how many clinics in Alberta are using OSCAR.

The answer is: about 6 clinics now.  There are also several Optometrists and a growing number of Specialist clinics that are making the switch from Wolf and other EMR's to OSCAR due to a host of frustrations with the proprietary EMR companies.

So how do you get OSCAR installed into your clinic in Alberta?

There are several ways to go about it.

Feel free to email me directly at drjohnf8@gmail.com and I'll get you pointed in the right direction.  Don't worry - it's easy.

One last item:  if you want an e-form made for your clinic (labs, x-ray, a history form, etc.) - just drop me an email.  I have a smart young Engineering Student that would love your business.  He's cheap, reliable and thoughtful.


JF




Monday, August 24, 2015

Alberta Labs and Billings are working perfectly

I have been real world testing OSCAR labs and the billing module for some time now.  A few beta issues were discovered and have been addressed.  The system is now working perfectly and is very reliable and robust.

OSCAR is also evolving, and a rewrite is being done to keep it super modernized.   I am looking forward to seeing some of the cool things hat they come up with.

In day to day practice in the Family Medicine and surgical clinics, OSCAR has helped to reduce admin costs, increase efficiency and it has assisted me with dealing with complex multi system patients and to coordinate and integrate health care services across a broad spectrum.

My income has increased by using OSCAR quite significantly and I am looking forward to leveraging OSCAR to further increase quality and access to care for patients with even further increases to practice income.  

I hear lots of gripes from other Docs regarding their EMR's - but I have no doubt that those gripes would disappear if they switched to OSCAR.  


Sunday, May 3, 2015

Alberta Lab Module just about here! Panelling patients - the NEXT BIG THING IN HEALTH CARE!

It looks like the Alberta Labs Module for OSCAR is just about here!

This is exciting news.  OSCAR-Alberta already has the best billing module available in the country.  Combine that with this new Labs module - and you have one kick-ass piece of EMR hardware.

The approval process with Calgary Lab Services just has to clear a last hurdle and we are off to the races!  Immediately, we will be able to act upon a new concept in EMR use called

"panelling".

Panelling allows us to group patients into subsets for analysis.  This allows us to increase the efficiency of delivery of health care in a timely, sensitive and innovative manner.

I know....blah, blah, blah......I sound like just so many of those amazing statements that just say nothing.


But this is different.

Let me explain to you the value of panelling via a world class, open source EMR like OSCAR:


Paneling has allowed me to increase the quality of care for my patients while simultaneously increasingly practice revenue.

Through paneling, I have been able to determine which patients are due for Complete Medicals, which patients are eligible for Complex Care Plans, and which patients are due for certain medication reviews and renewals.



My office is able to recall such patients in order to book them for necessary appointments at appropriate intervals.  Complex Care plans are performed for all eligible practice patients, and these types of appointments are scheduled throughout the year. This allows us to review and optimize patient care for complex multi system patients while increasing practice revenue for providing this service.

Paneling also serves to allows us to determine, for example,  how many diabetic patients we follow, and to determine strategies to optimize care.  This allows us to create multi-patient appointments to familiarize newly diagnosed diabetics with their condition and to talk about the initial approaches to assessment and treatment.  





These panelled groups of patients are able to form discrete cohort groups that support each other through their diagnoses and to optionally subscribe to office-managed email newsgroups for ongoing self-supportive care.  Paneling allows us to match certain groups of diabetics to each other for potential “micro-communities”.  For example, newly diagnosed juvenile diabetics (and their parents) would not be matched to newly diagnosed elderly diabetics.  One particularly successful “micro-community”, for example, is our group of newly diagnosed Philippino diabetics.  These folks love getting to know each other and to get together for “diabetic meal” potlucks, etc. and to share diabetic meal recipes consistent with their culture.





Regular appointment meetings are organized with these various micro-communities, which brings efficiency of assessment and treatment to these groups in addition to increased practice revenue.

The same panelling approach is used to identify groups of patients with other similar disease states like groups of patients with: Idiopathic Pulmonary Fibrosis, Sarcoidosis, Irritable Bowel Syndrome, Depression, Bereavement, Congestive Heart Failure, Diabetes, etc.





While the diseases make paneling of these patients possible - it is the patients’ similar disease experiences that bring them together in these types of group appointments that turn into micro-communities within the practice.

This community-based approach to creating “micro-communities” within the practice, greatly enhances quality of care and gets appropriate people with similar disease profiles and social circumstances connected.

Brokering such group patient interactions through the assistance of paneling activities increases patient quality of care on several levels, and also increase practice efficiency and revenue.



Paneling also helps us to identify patients at high risk for certain disease states.  For example, we are able to ensure recalls for patients with strong family histories of bowel cancer, renal cell carcinoma, etc.  Patients will schizophrenia and major depression are also regularly “checked on” so that these particularly vulnerable patients do not fall through the cracks in our increasingly chaotic and poorly organized health care system.


OSCAR's open source EMR allows us to harness the power of an open source format to do sophisticated panelling for our patient population.  This is better for patients, for Physicians and for the tax payer!



Monday, September 22, 2014

I like MY OSCAR EMR Setup....but I'm getting sour about EMR's as I think about them

Wow.  June seems like just the other day.  I was all glowingly positive about getting an Alberta LAB module done for OSCAR.

Two people have approached me about it.....one stated that he has an Alberta Lab module built....but he has disappeared in puff of smoke (no, I was NOT smoking anything).....and the other guy said that he was close, but needed an extra $15k or so.  I pledged my $5k, but I have not heard any further discussion about the matter.

So what's up?



I've been thinking about this whole EMR thing and I have to say - I've become disenchanted about the whole EMR concept.

My disenchantment towards EMR's came as a surprise to me.....after I followed an esteemed 85 yo colleague around for a bit at his busy and thriving rural practice.

The practice was a model of efficiency that was "time warped" back to the 1950's.  It was clean, neat and extremely efficient.  This old fellow had an EMR in the office - but he had never seen it.  His office was very modern - even including the XM radio channel that softly played through the waiting room for the sakes of his patients.  He knew what XM radio was, but he just didn't really care to know much about it.  His office manager organized "all that stuff" for him.



I have not chased an Alberta LABS module for OSCAR as aggressively as I could because I don't see much real benefit to it anymore.  Alberta has a really good EHR now, that I can simply keep open in another browser window on my laptop.  I can very easily do a patient search on the EHR and get any labs that I want at any time.  Also included is all LAB/PATH/DI/CONSULTATIONs as well as DRUG Hx on Alberta's Netcare.  I can easily copy/paste anything into OSCAR.

The only thing that I am missing is the ability to analyze patient populations in order to conduct population health audits....ie. how many diabetics do I have that require optimization of their meds due to sub-optimal lab results.

At the end of the day - while it would be good for patients if I could have this functionality.....I would have to undertake that work at my own personal cost in terms of time and income.  There are no rewards or remunerations for Physician in Alberta to do population analysis and health optimization.  This is clearly stupid - but we have a health care administration in Alberta that is not known for its cleverness and efficiency (quite the contrary).

LONG STORY MADE SHORT:

At the end of the day, it seems that the "Real" purpose of an EMR is to download menial clerical activities to Physicians in order to waste their time and expertise.   In the old days of simply dictating a note and having a Nurse follow me around to make notes and chart discussions - we used to be a LOT more efficient.  The use of EMR's in the hospital and clinics by Physicians has probably contributed to at least a 50% deterioration in Physician efficiency.  


This elderly Physician that I followed around for a couple of days literally blew me away with how efficient he was. He rarely looked at a piece of paper and he was totally 150% focused and concentrated on his patients. He missed absolutely nothing.....from the slightly crooked crease in a Mom's ironed slacks (clued him into the carpal tunnel disease).....to the subtle lack of attention to "normal" makeup and hair styling in a young lady (trying to secretly battle a suicidal depression). He had time for everyone and carried himself through medical interview after interview with an unhurried regal dignity that I have promised myself to emulate as much as possible as I modify my practice to mirror in like over the next couple of years.

His staff followed him from room to room and they made notes, looked up labs and handed him information on a tablet - all in a seamless ballet of medical astuteness, efficiency and ultimately - caring.


Most "modern" Physicians that have never practiced "the old way" could not fathom the cost of having a full time nurse and transcriptionist follow them around all day long.  Now, such Professionals would cost us about $80,000 for the nurse and about $50,000 for the transcriptionist.  This translates to about $550 per day in increased overhead costs (a 400% increase from what the same services would cost only 25 years ago). Almost all EMR's are a bargain compared to this.....except that they totally ignore the value of a Physician's time.....which is about $4000.00 per day.  EMR's easily waste about 20% of that time and so they real cost of an EMR is about $800/day.  Probably better to hire a full time Nurse and Transcriptionist at only about $550.00/day!

Yes, you may argue with my figures...but you would have to argue proportionally if you want to challenge the above numbers.....you'd still lose the argument "for" EMR's.
Sorry to blather!  I've just been feeling frustrated in poor EMR design over the past couple of years.  You should see how I use OSCAR....I maximize the "awesome" in it and totally ignore the "time wasters" in it.  This approach has probably doubled my efficiency and income.

I am going to gradually transition to having more staff in the office to undertake more of the clerical tasks that OSCAR is trying to assign to me.  I will dictate notes into OSCAR via voice transcription, and I will write Rx's using OSCAR's prescription module.....but I think that will be it.  The rest of everything OSCAR can do will be delegated to other staff.  I have started to miss my patients behind the fog of the computer screen and I want to get back to them.



Wish me luck.


Thursday, June 5, 2014

Great news for OSCAR in Alberta: A LAB MODULE IS POSSIBLE!

It looks like the tech wizards have invested some time and effort - and have decided that a Lab Module for OSCAR in Alberta is possible to do within a few short weeks!

The cost for development is about $100 per hour, and it is estimated that we need about $15k to get this done properly.

We probably have about 60% of the money we need, and I'm looking for a bunch of good young men, women or other that would not mind contributing a bit to the fund to get this off the ground.

We ARE going to get this off the ground!  It would just be nice to get it done sooner than later.

If you're willing an able - just send me an email to:

drjohnf@me.com


And I'll make the necessary connections.

Hope to hear from you!

John Fernandes.