Thursday, January 29, 2009

The Roadmap to getting OSCAR going

I've learned the real secret in getting OSCAR going in Alberta:

It's all about establishing relationships.

I've decided that it is not enough to simply install OSCAR in my office on a single computer.  What I really want is an established hardware/network/software support foundation to not only help me get OSCAR going - but to help others get it going in Alberta that come after me.

And so, I'm going to try out a well established company called Layer 10 in Calgary that provides hardware and network installation and support.  They understand the concepts of redundant backups, RAID configurations, redundant servers and remote access.

This is mission critical work, and no amount of possible "down time" will be in any way ever acceptable - even if the power goes off.

I'm currently awaiting a quote on a couple of mirrored IBM servers from Layer 10, and will go forward probably some time next week (depending on the price).  Linux Ubuntu will be supplied and running on the servers by the Layer 10 folks.  

The next step will be to become an accredited submitter to Alberta Health.  This involves some paperwork that I have to fill out and fax back next week.

The next step after that will be to fill out some paperwork to get the Calgary Health Region to port HL7 data into OSCAR.  To access this, I have to fill out some other application forms - which I will do next week as well.

Did I mention that since I started this crusade, the Calgary Health Region has ceased to exist?  Some "progressive politics" in Alberta has decided to do away with regions in favor of a more streamlined Provincial Medical Administration.  Probably a great idea, but dealing with the Region is now even more confusing than it was before this new change.....

I THEN have to eventually ensure that OSCAR becomes "VCUR compatible", so that POSP funding will eventually be able to support it.  

Some very decent and generous people that I have met through the BC OSCAR users group have offered to help me get an Alberta Billing module and Calgary Lab Services module built for Alberta.  Hopefully, because a lot of groundwork for Ontario and B.C. has already been done; this will not be too much of a task - but I anticipate a few road bumps.

I have received the "H-Link" manual from Alberta Health.  It was last published in the Cretaceous era, and has not been updated in a paper version since.  An updated electronic version does exist, but Alberta Health is apparently unsuccessful in emailing the large document.  I've scanned the whole "older document" and have posted it on the site above.

So - practical things first in the next orders of business:

1)  Get my server(s) (Layer 10 folks to help) and then install OSCAR on it (kind list folks to help).
2)  Get my network going (wireless and wired.  Layer 10 folks to help).
3)  Become an accredited Submitter for Alberta Health (paperwork needed)
4)  Become an accredited Receiver for Calgary Lab Services (paperwork needed)
5)  Get OSCAR VCUR compliant to eventually qualify for POSP funding (a long-term goal)
6)  Get an Alberta Billing and Labs Module set up
7)  Get a scanning section of OSCAR going so I can eventually be "truly paperless".
8)  Talk to Radiology Consultants to get their techies to help me integrate a connection from OSCAR to view Diagnostic images and reports (Region Wide).
9)  Learn as much as I can about Linux Ubuntu and Java programming.  Bought some books on this stuff - this looks like a good choice.....

Saturday, January 24, 2009

I want OSCAR - what now?

I was very excited to finally make a decision on an office EMR.  The idea of having a system that was essentially "free" and a system that was never going to be obsolete is perfect!  I KNEW I had to have it.

My software costs of implementing a $2500 per month EMR (average total cost) over the next 20 years would have been $600,000.00!  OSCAR will cost me $0.00 (though it'll probably cost me something to get billings and Labs going for Alberta for it).

So - I started with the initial advice of a fellow Physician named Jel from B.C.; who suggested that if I didn't get OSCAR, that I'd be a "lollygaggling, closed-minded, knobbleheaded, nit".  

Jel is British and I believe that in the language of his people, that this extemporaneousness in his native tongue, loosely translated as "silly".  I "Googled" OSCAR, and came up with all kinds of things that ranged from a certain way to prepare Scallops to edible thong underwear.

This approach was less helpful than I had hoped, and I inquired with Jel as to where to go for more information.

So Jel pointed me in the right direction and told me about the "OSCAR CANADA USER's SOCIETY" and that this website should answer all of my questions.

The problem was that the website appeared to contain some incomplete links, and it also appeared to be geared to folks that already KNOW all about OSCAR and what it was all about.  There were lots of URL's and acronyms that stood for arcane things that weren't explained or easy for this uninitiated neophyte to understand.

So - I did the only thing that a highly trained Physician and Scientist could do.....I bitched to Jel.

He then turned me on to the BC OSCAR Society email user's group (  This group contains a bunch of experts and simple users that email each other daily about their inspirations and insights regarding OSCAR.

These folks were immediately welcoming, friendly and very helpful.  They occasionally communicate in some sort of high arcane language more akin to something one would expect from an intergalactic Star Trek Vulcan species rather than the cave-dwelling, crotch scratching slightly evolved ape species with which I seem to have more in common.

But I learned that I have to have a "server" in order to run OSCAR.  And the "server" had to have Linux on it.  And the "server" had to have a particular version of Linux on it, called "Ubuntu".

So I went to Chapters and bought a book on Linux Ubuntu as well as another one on Java.  Both were 800 pages, and I'm about halfway through both of them.

So, I looked high and low and ended up going to a computer store to build and configure my server.  I then happily downloaded "Ubuntu" (the 64 bit server version), and installed it on my "high-end" server.  

Then I watched my server crash.  And crash again.  And again.  And again.  I could run Ubuntu easily from the disk, but apparently you can't install Ubuntu on anything that has a RAID array.

So I went back to the computer store and preached my woes - and they scratched their head and said sorry and offered me a full refund - which I took.

I then fumed about how in the world I would get an "OSCAR SERVER with UBUNTU already running on it".  I knew that I could order one "ready to go" from the OSCAR CANADA USERS SOCIETY, but I wanted to purchase locally in case I had hardware issues that needed immediate repair.

So, a week rolled by while I mulled my options - and I did what only a highly educated Physician and scientist could reasonably do under the circumstanced - I bitched about it to my nurse during a surgery.

I happened to be dissecting a painful mass from a sensory nerve in the back of this poor fellow, while bitching to my alway sympathetic nurse (at least she looked sympathetic - I suspect that she was actually listening to her ipod).

The fellow I was operating on listened with a great deal of sympathy - and as it turned out, he happened to be a bona fide computer/networking professional that had heard of Linux and Ubuntu and even OSCAR!

So at last I had someone local that could supply and configure my hardware!  He is going to build me exactly identical servers that will mirror each other redundantly, and run "mirrored" simultaneously while saving Data externally on a RAID that will also be backed up on a tape drive.

He builds IBM systems, and that company appears to have a "business level" support system and build quality that defines the industry standard.

So now I sit and wait and plot the next step.....

Sunday, January 18, 2009

On deciding upon an EMR (Electronic Medical Record)

As a full-time, full-scope Family Physician with an additional consultation-based office surgery practice, I have been immensely enjoying the practice of Medicine as it was meant to be practiced.

I am my own boss, I set my own hours and I actually like everybody I treat and interact with on a daily basis.

But, as the complexity of disease and our understanding of it increases - along with the expectations of our patients; I have been slowly getting literally buried under mountains of paperwork.  I am becoming slowly aware that I am having to spend more time on patients' paper than their actual bodies and minds, and this is clearly not the intention of our great forefathers that developed and created this wonderful profession.

Part of being a Doctor is to advance the knowledge of the profession and to eventually enable those that replace us to stand on our shoulders.

To that end, I find that I am coming to the point that I cannot continue without solving the problem of the paperwork that is trying to drag me down and pull me away from the Medical Frontier that I am supposed to be working to expand.

I have read numerous blogs, opinion articles, advertisements and posts from various Physicians and other parties that extol the virtues of an Electronic Medical Record (EMR).

So, a few years ago, I tried to install one in my office from a Vendor that provided an apparent "turn key" solution.  The experience of the process was poor, and the Vendor ended up going out of business - along with my data, which was held hostage.

Determined not to repeat that experience, I looked to my Provincial Government and Medical Association for some guidance and direction (both had been extolling the virtues of EMR's and how they would financially and otherwise support the departure from paper).

What I realized was that, unfortunately typical of government sponsored programs, the department responsible for helping Physician adopt an EMR, quickly became a source of an additional and needless administrative headache and additional mounds of paper.

Moreover, these agencies forced you to use one of three "approved" vendors for your EMR.  I have reviewed the software and support quality of these vendors, and have been far less than impressed with their approach to helping me with my mission critical work.

As such, a colleague of mine suggested that "Open Source" would be the way to go, and I quite agree!  The advantage is that the system is free and under constant evolution by the end users.  The system also runs under the extremely stable (and free) Linux Ubuntu operating system.

The system is called OSCAR, for "Open Source Clinical Application Resource", and a great description of the system is here at the OSCAR PEI Blog.

This Blog is basically a description of my trials and tribulations experienced in installing OSCAR in my office..........wish me luck!