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!

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........