The current status - my server DIED!!!!!

I got a call at 05:00 on Sunday morning....not all THAT unusual with my practice....but still not fun. It was the security guy from my office. Apparently, a "bad surge" hit my office and the power was out. I headed over there to try to see how my status was....and my server DIED.

My APS was also fried - and it did NOTHING to save my server! My backup server was okay, but was not operating quite properly....so the NERD BC guys were "on the job" immediately.

I have to say - these NERD BC guys are truly amazing when it comes to availability and when it comes to solving weird problems. They're going to go far. I'm very happy to be working with this brilliant and forward thinking team of two young men.

My offsite backup was thankfully just fine, and so they they uploaded the backup to my backup server while I get the primary server fixed.

They installed the 64 bit version of Ubuntu first...followed by OSCAR 10.06 - and I am IMPRESSED with how much better and faster this is! I'm installing more RAM tomorrow - just bought 4 more Mb RAM for each server, so I'll have a total of 8 Mb per server now. Apparently, I'll have even more performance once I get this going (on top of my 32 Gb SSD Hard drives).

I'm going to install a new APS on each server - and THIS time, I'll set them up properly with a USB data controller to turn off the servers if they are about to fail (and email me with a status).

The billing/lab module is about 70% complete now. Things will go faster now, as the Programmer (very talented) has brought her knowledge of the project up to snuff and is now basically coding on it full time. I think that a more realistic timeline for testing the finished product prior to deployment will be the 3rd week or so of November.

Where are we? HERE WE ARE! Final Strech

We are starting to receive some pledges for helping to fund the last 100 or so hours of programming for the Alberta Billing and Lab module. This is becoming a life saver, because it is not cheap, and even OSCAR programmers need to eat more than just Ichiban.

The programmer, I am told, has not been coming up much for air lately - and she is a very talented (and I'm told good-looking) programmer. I hope to meet her one day (not because of her looks - I'm married to a devastatingly beautiful woman already).

More Physicians are contacting me about OSCAR and there seems to be a lot of genuine interest in OSCAR in Alberta. Within just 2-4 weeks, we should have finally an Alberta Billing and Lab module for OSCAR.

I have recently installed Netcare in my office. This is a wonderful thing that has made a real positive difference to patient care - and it saves me hours per week.

I'm normally happy to enthusiastically criticize the Provincial Government.....but I have to grudgingly agree - NETCARE IS BRILLIANT. Whoever was responsible for coming up with the idea, will probably save countless numbers of lives, countless suffering and countless Health Care Dollars. Whoever you are: Thank-you.

We will attempt to also build a Netcare connection to OSCAR, as this is a logical next step.

Many have asked me why I am not pursuing VCUR compliance to receive POSP funding from the AMA.

My answer is: what for?

POSP funding is a nightmare of paperwork that gives Physicians grey hair and high cholesterol....and the costs of OSCAR are so insignificant, that the hassle of obtaining POSP funding for it does not seem to be worth it to me. It will be interesting to see how this issue evolves....but we will perhaps go after VCUR compliance after these several things are done:

1) Alberta Billing and Lab Module Complete

2) Alberta Netcare interactivity module complete

3) OSCAR ISO certification complete (being worked on by fine folks)

4) OSCAR takes over most EMR installations in Alberta

Feel free to contact me at any time at:

Drjohnf@me.com

My Twitter is at:

@Drjohnf8

Billing/Lab module has a light at the end of the tunnel.....

Alas, we now have a light at the end of the tunnel with respect to Alberta's Billing and Lab module.

And no worries - we are keeping it totally "open source", which means that everyone will be able to have access to it.

This has been difficult and expensive. Anybody that would like to contribute funds towards this (to help alleviate the financial pressure on me) would be most welcomed! To be a wonderful, benevolent and altruistic spirit - please feel free to email me at:

drfernandes@me.com

if you'd like to be able to help me accelerate development with a little infusion of additional funding for this project.

Hopefully we'll be able to beta test by mid-October to late October. I fully intend that I will not see 2012 without a functioning Alberta billing and lab module for OSCAR.

I've started an OSCAR Alberta discussion newsgroup - much like the BC group, but it is intended for OSCAR Alberta specific concerns and discussion.

Anybody that is interested in this newsgroup is welcome to join up! There are not a lot of members yet, but perhaps more will join in time. Within the next few weeks, there will be a few clinics in Alberta that have adopted OSCAR. I hope to have these clinic members participating on this list.

To subscribe to the OSCAR ALBERTA newsgroup - please feel free to visit the following link:

https://lists.sourceforge.net/lists/listinfo/oscaralberta-discussions

Because things are starting to heat up on the OSCAR Alberta Front....I am going to post at least once every couple of weeks with an update as to our progress.

John Fernandes.

OSCAR-ALBERTA: failed attempt initially - but rebooting now

OSCAR-ALBERTA development has not progressed as fast as I had hoped, for many reasons.

The task was daunting, and my initial approaches did not bear fruit.

HOWEVER - I'm trying a new approach. The OSCAR-ALBERTA billing and lab modules will be all open source and available to anyone that wants it. I hope to have some real progress by September.

I will personally bear the costs of this venture - and will give it away. So anybody that has a mind to help my pay for this would be most welcome. I estimate that I'll have to collect about $10k or so (conservatively......just getting an estimate figured out now). Altruism is great - but it's hard to do it all by yourself.....but I will if I have to.

In the mean time, please feel free to subscribe to the OSCAR-Alberta list server on Sourceforge.

Please go to the following website and register for inclusion on the newsgroup server:

https://lists.sourceforge.net/lists/listinfo/oscaralberta-discussions

This is basically a service where subscribers have the ability to post any OSCAR-Alberta related question - and get an answer from other subscribers. The BC list is very good, and has a strong user base. The users help each other with all things OSCAR - and this is one of the many things that makes OSCAR unstoppable.

So please sign up and feel free to ask or answer as you like. No questions are too simple, and all comments and questions are most welcome!

I'd like to build a large user base for the OSCAR-ALBERTA List Server.

I remain the ongoing optimist!

JF

Billing module nearing completion within a week or so

Okay, so I've been playing with the Alberta Health Billing module in OSCAR and it looks pretty good. We are making some slick changes to it so that it integrates very well into a busy Physician's workflow.

The changes should be ready within a couple of days, and I will be testing it on a fake patient database before doing a live billing trial in my office.

Labs module is basically going to happen at the same time.

Great news for people interest in OSCAR.

I am aware that only 3 vendors are "approved" vendors for Alberta for POSP funding. I had considered making OSCAR "VCUR compliant" so that it can be qualified as a 4th vendor.

I might just go ahead and do that.....but I can't think of any reason to bother.

The paperwork and administration involved in getting POSP funding to cover a measly $250 per month for OSCAR support (including billing) is not worth the painful time and effort to get and maintain POSP funding.

I have had many inquiries from Physicians who are ready to leave POSP behind in favour of OSCAR.

We'll see how things transpire - but I think that in the long run, OSCAR will take over in Alberta and the POSP office will have to evolve to keep up with it. I would welcome a collaborative effort, but there is currently an understandable lack of interest from their end.

That will hopefully change over the next couple of years.

OSCAR via the iPad - damn! Works GREAT!

I seem to have been able to make the iPad actually useful in clinic with OSCAR.

The trick seems to be to install Printopia on any Mac in the clinic that is able to print on any printer.

Then, install text expander on the iPad & make it sync to my MobileMe account.

Clinic notes are then a breeze to enter into OSCAR with text expander, and longer notes are simply dictated into the ipad using Dragon. All specialist referrals are dictated, then copy/pasted into the consultation.....then faxed directly from the iPad to the specialist with the patient in the room! Yes, occasionally I will type a note directly or via a blu-tooth keyboard....

Prescriptions print seamlessly from the iPad to any printer I select, and I use Dropbox on the iPad to print out patient pamphlets when necessary. I often now also email them to patients from the iPad.

Uninsured services (like sick notes, etc.) are also paid for immediately using the iPad, directly into Paypal, and receipts are emailed to the patient or printed. The IPad's multitasking makes this a breeze!

The iPad with the camera will make it easy to attach photos of things to patient notes. Can't wait to get that in April!

JF

BTW: had to work during superbowl - so used the TiVo app on the iPad to schedule the recording in the USA remotely, then the sling box app to stream the recording later to the ipad while at the office doing my paperwork. Made it bearable.

A cool feature with OSCAR

I just had to state something very cool about OSCAR that you can't get with any other EMR.

I connect to OSCAR using my laptop, which I carry with me from room to room as I move around the office. I also drag my laptop with me down to the pharmacy, to my personal office and the lunch room, etc.

I use a Macbook Air, because it is simply the best portable laptop out there. There are simply no better machines for use with an EMR. Sure, you can cheap out and buy a windows machine. They certainly cost a lot less. Mac's are expensive - but let's face it. If you want OSCAR, chances are that you are an M.D. If the cost difference between a (high end) Mac and a (low end) PC is something that makes you lose sleep - then Medicine as a career is possibly not meeting your financial objectives. That is a huge potential can of worms that is beyond the scope of this blog.

Suffice it to say - if you want the best possible experience with using an EMR with OSCAR - then use Mac's. I chatted with my support guy about this, and he pointed out that >95% of his "support calls" are a result of some strange quirk of windows that is messing something up for one reason or another. He rarely gets a request for support from a Mac user.

Mac's just work. Always. For mission critical operations like the business of a Physician - that should say a lot.

.....so: back to my story.....

With the Macbook Air, I run OSCAR on Mac's browser: Safari. This works seamlessly and is very smooth. Works also on my ipad and iphone. But even cooler: I can configure safari to display a "ticker tape" at the top of the browser that gives me up to the minute weather/temperature reports in Calgary....as well as the time/date and a rolling RSS feed from the Calgary Herald and any other RSS feed I like.

Yes, I know what you are thinking - I do pay attention to my patients and I do not stare at my computer screen while they are talking. But with the few seconds I have between patients - it is an amazingly cool way of "keeping up" with the world.

I also have "Facetime" on my Macbook Air. This means that my wife and kids can reach me directly and personally with a direct audio/video chat directly on my air instead of me having to pick up my phone. If I'm with my patient - they know that I will answer and then put them on hold.....then I simply walk out of the room and we have our quick chat.

They never call me about anything insignificant - I only get the infrequent call like, "hey Dad, does this wound on my arm look like it needs stitches", or "Hey Honey, I'm at Grandpa's, and his left calf is swollen and red and looks like this....should I bring him in?....".

Something beyond PG-14 video chats from my wife - though MORE than welcome....seem to not have been coming my way. It would seem that she doesn't entirely trust the digital medium all that much. Ah well....time may mend that.

Just in the process of validation of the labs and billing.....should't be long now......

Update January 2011

Geez!

Has it really been two months?

A lot has happened since then. OSCAR development has been going full tilt all along. The waiting time has been due to the fact that it was decided to do a whole new rewrite for how Labs are inserted into OSCAR. Alberta's version is going to do this properly by taking the "flat" HL7 file (version 3) and then inserting relevant lab information into each patient's chart.

This is better than a more common method of having OSCAR scan a large flat file of lab values and then populating your screen view with those values. Took a little more fussing, but it should all be done next week. Finally.

The billing program is also going well. It is going to be much more robust than billing modules seen in other provinces - especially the private billing module. Private billing is now what pretty much keeps many Medical Practices viable, as Government pay for Medical Services is keeping less and less pace with the real world costs of running a Medical Practice.

As it turns out - many Physicians with robust private billing activities are staying in business (and able to see patients under Alberta Health) while Physicians that do not participate in this sort of thing are increasingly going out of business.

People might get their backs up over this issue and march around in "protest" to defend health care. I applaud these people and wish them well. But when they accidentally "protest march" into the path of a fast moving bus....I will be there for them in my office and by their hospital bed because my private billing activities have kept me from moving to the U.S. when insured Physician income in Alberta is failing to keep pace with escalating office costs.

So where are we? We are on the cusp of having hopefully three more clinics in Calgary adopt OSCAR before spring. These are all new installs - although my OSCAR support person has a decent amount of experience in converting Wolf to OSCAR. A 4th clinic is considering adopting OSCAR because of the exorbitant costs associated with upgrading Wolf - and the increasing challenges they are facing with the administration of their POSP funding.

I hear frustrations with the POSP funding, increasingly in recent months. Hopefully OSCAR will eliminate this by making POSP funding unnecessary (as well as the mountains of paperwork that seems to be attached to getting the funding). OSCAR costs so little, that POSP funding is essentially unnecessary.

I have asked the AMA to take an interest in OSCAR and to consider supporting it. Didn't go very far. They are sticking to their guns in an admirable demonstration of loyalty to their three "supported vendors". This is probably a good thing, but it is inevitable that OSCAR will take over in Alberta - and I trust that the AMA will eventually catch on.

So...hopefully I will be able to blog by the end of February that my billing and labs module for OSCAR is working beautifully. By then, the ipad2 should be out and it should be able to print prescriptions.

In the mean time, I am going to make some swanky new e-forms for Calgary Docs that I plan to give away to any and all who want them.