THOUGHTS ON OSCAR AS AN EMR
PAPERLESS PRACTICE
A lot of Physicians seem to have the goal to "be paperless".
While this is possible - it should not be a mindless goal just for the sake of being totally paperless in some sort of non-existent ideal to be a super duper Physician that hugs a lot of trees.
The fact is that paper is still much more efficient than any sort of digital medium in many ways. Most practices should strive for efficiency rather than unattainable goals.
While you CAN scan the load of paper (we get about 20 lb PER DAY) into OSCAR, it HAS to be done by somebody that is pretty much devoted to it full time. Doing this in OSCAR takes a significant amount of effort, typing, organizing and mouse clicks, and is not for the faint hearted.
Additionally, accessing the information later is TERRIBLE. There are simply not enough descriptive fields in OSCAR to be able to adequately and efficiently/sufficiently describe each and every little piece of paper that you scan into a patient chart. I have found that scanning the odd paper report into OSCAR is okay - but to scan everything would be a pretty much fruitless an unrewarding task until the method of doing this is essentially redesigned.
For now, we scan only the essentials into OSCAR and keep paper files on patients for consultant reports, etc. This seems to be the real sweet spot for efficiency.
Electronic Scheduling
While some practices seem to like doing this on a computer screen - my staff tends to have to multifunction and they HATE using OSCAR's scheduling program. The program is basically too inflexible for real world use, and appointments seem to change with great rapidity.
We have found that the smoothest and fastest and most efficient way to schedule patients, is to do a traditional paper schedule - and then transfer that schedule into OSCAR the day before the actual day of service.
Our scheduling is done through an artfully applied combination of triage and "active scheduling" that makes use of time analysis and which considers patient needs. For example, some patients only need a two minute visit to renew a prescription, whereas others typically take 20 minutes due to multiple complex issues.
OSCAR's scheduling program is not all that flexible and seems to require an inordinate number of mouse clicks in order to accomplish the simplest of tasks. This is not a criticism, but rather our observation. Lots of offices seem to like OSCAR's scheduling system, and I suspect that those offices tend to have full time office reception staff that do little other than schedule patients.
ELECTRONIC LABS
Lots of people that use OSCAR in BC use a third party to deliver lab information directly into OSCAR. While there are good and bad things about it, it seems to be working for them overall.
In ALBERTA, Alberta Health, who has taken over Alberta Lab Services, has decided to no longer play nice with EMR's outside of their bizarre and arcane approval process that has been highly politicized and essentially ground to a halt as a result of bureaucratic inefficiency and paralysis.
I could go on for hours about Government inefficiency and how it adversely affects almost every level of Health Care, but most of you are probably already aware of that.
NETCARE
Having said that - while I remain personally critical of the administration of Alberta's Health Care system, I have to grudgingly applaud Alberta's approach to dealing with Electronic Lab information. In Alberta, we have a Provincial Electronic Health Record (EHR) called, "NETCARE".
Accessing Netcare is simple, and it can remain on your computer desktop in the background. Through NETCARE, you can access any Lab, DI and a growing list of diagnostic tests that every Alberta patient has had in the past 3 years. Soon, we will be able to access referrals to Specialists, Special Services and estimate "real world" wait times.
So while I personally find it tempting to criticize our Politicians and Health Ministers - they have actually built something to be greatly admired and which is unique in North America. Every patient in Alberta will have an EHR chart that every Medical Professional will be able to access.
We frequently copy DI reports, etc. from NETCARE into OSCAR when needed - but, I cannot seem to find any instance where I would need to bring lab information from NETCARE into OSCAR.
While it is a bit of a bummer to have to log in simultaneously into the patient's EHR (NETCARE) and the patient's EMR (OSCAR) - I really think that this is the wave of the future. In fact, I can see that one day, Physicians may have the option to use the EHR instead of an EMR if they want to. I would personally never do this, as to do so would require an inordinate amount of unjustifiable trust in Government and its attendance to the exclusive responsibility of being the custodian of the patient's electronic medical records.
Suffice it to say - ELECTRONIC LABS into OSCAR are probably unnecessary. It would be cool to be able to data mine for our practices and to make use of OSCAR's tools to figure out which of our diabetics, for example, has undesireably high Hba1s levels....but Alberta's EHR is shortly going to be able to make this happen anyways.
There are some dangers to this. "Pay for performance" is looming in Canada. EHR's will allow Administrations like Alberta Health to pay a Physician less for "lack of performance". For example, if you have a patient who is a 450 lb diabetic on a diet of twinkies and root beer - you will not be paid for the high sugar levels that are indicator of your poor "performance" as a Physician.
The obvious answer to this is that many Physicians will simply abandon patients that become financial liabilities. Colleges will naturally "forbid" this, but that is rather like trying to herd extremely smart and irritated cats into doing what you want them to do. They will ALWAYS outsmart you.
It will be interesting to see how this plays out. For the time being, however, NETCARE is awesome, it's growing and it works very well symbiotically - though independently from OSCAR.
PRESCRIPTION WRITING WITH OSCAR
This is the cat's meow. I have seen most of the EMR's available in Canada, and none of them even comes close to OSCAR's ability to write, review and renew prescriptions. There are a lot of tools that work together symbiotically to make writing prescriptions in front of your patients quick, efficient and a real pleasure. You can even sign the prescriptions with a "wet signature", which is required by the Colleges. I now use a YOGA 2 pro in the office, and sign prescriptions right on the screen. While I'm sure that there are some ongoing improvements made to the prescription module - it is probably one of the best in the world.
PATIENT NOTES
Recording patient encounter notes into OSCAR is very easy in the "toiletpaper roll". This is just a roll of notes that start at the top and go down chronologically. They are separated by date and are entirely searchable.
I frequently dictate my notes into OSCAR using Mac's or Windows 8's speech recognition in the operating system. Between dictation, typing directly and using Text Expander (Mac) or Breevy 3 (Windows 8) - my capture of very detailed patient encounter notes is extremely efficient.
In addition to dictation, typing and text expansion; I often use templates in OSCAR. For example, in the search field at the top of the toiletpaper roll, I simply type "CFM" and a template is displayed in the toiletpaper roll in the patient notes field, that displays my template for "Complete Medical - Male". I just fill in various details from the medical encounter and I'm good.
I have the same approach for "Dysuria, Abdominal Pain, Back Pain, etc., etc.
OSCAR's patient notes capture is possibly the best of the best in EMR's.
E-Forms (Electronic Forms)
You can make forms easily in OSCAR for DI, lab services, etc. I have made a ton of these forms for Calgary Labs, EFW Radiology, Radiology Consultants, etc. You can pre-populate these forms with information from the patient charts, such as demographics information, medications, allergies, medical history, etc.
Making forms is easy using the "E-form generation tool". There is a bit of a learning curve to using the tool, but it really isn't all that bad if you have enough alcohol.
CONSULTATIONS
Creating consultations in OSCAR is easy, but you have to go to the main screen to be able to enter a consultant into the database. This is a HUGE PAIN, because sometimes you have to do a consultation for a patient - right in front of the patient. There is no way to enter a new consultant into OSCAR's consultant database from the screen where you actually create a consult request letter. OSCAR automatically does the patient demographics, appointment scheduling (with the consultant), meds/allergies/patient history. Notes can be then faxed directly to the consultant's office directly from OSCAR.
OSCAR Messenger
This is like an internal message system for you and your staff. It is very useful to ask staff to check on this or that, or to accomplish various administrative tasks or patient checks, etc. They can also send you surreptitious messages while you are with the patient, like (patient is depressed because they are getting divorced, but they didn't want to bring that up with you today), etc., etc. The messaging system is an indispensable tool.
Billing Alberta Health
ClinicAid has written a billing module for OSCAR. The company that developed the billing tool has done a crack job at it, to the point that it is probably the single best billing program available in Canada. They are new on the block and are looking for new clients. I am happy to recommend them. Billing happens right on the OSCAR screen so that by the time you exit the patient room - you are done billing already for that patient visit. I save each billing, which is reviewed by my office billing staff and then submitted at the end of each work day.
One thing that could really enhance ClinicAid, would be to add a private billing module to is so that you could easily keep track of private billings, which can amount to 25% of practice income these days. Printing invoices for patients would also be an ideal thing.
The billing module has not been out for very long, but it is already hands down the best billing module in Canada. I can't wait to see how it continues to evolve.
Measurements
This is NOT very good at all. The intention is to be able to record blood pressure, height and weight. It's cumbersome and takes an inordinate number of mouse clicks. But if you bother with it, you can easily generate a graph of blood pressure or weight, etc. Hopefully this will get redesigned in an OSCAR update, but for now not very many OSCAR users make use of this (I tend to bother with it, hence my chronic frustration with it).
Preventions
This COULD be incredibly useful, but it isn't the way it is set up. With this module, you can organize OSCAR to set reminders for PAP tests, Colonoscopy, PSA's, etc., etc. You have to get your OSCAR service provider to customize this list for you a bit before it can really be used. Once it is customized, I imagine that it will lend to increased quality of care in your practice.
FINAL THOUGHTS
OSCAR has several other features that are a little more arcane, but which could be incredibly useful. I'm going to start exploring these more, and I will ask my OSP to customize these a bit. The Oscar Service Provider (OSP) I use is NERD (Northwest Electronics and Design). They're awesome.
I will be making more updates to this blog, so please stay tuned!
