OSCAR: the best EMR (Electronic Medical Record) Comes to Alberta

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

2011-10-17T20:50:00.000-07:00

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

2011-09-25T22:52:00.000-07:00

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.....

2011-09-11T22:16:00.000-07:00

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

2011-07-27T23:29:00.001-07:00

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!

Billing module nearing completion within a week or so

2011-05-03T22:15:00.000-07:00

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!

2011-02-14T22:48:00.000-08:00

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!

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

2011-02-06T17:33:00.000-08:00

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

2011-01-18T22:17:00.000-08:00

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.

Status update for OSCAR

2010-11-05T22:06:00.001-07:00

A talented Physician/programmer just wrote a "web page app" that allows you to make your own e-forms for OSCAR.

This means that if you have a "form" that you use regularly - like a lab form, a Radiology referral form or a specialist referral form - you can have it rendered into a "computerized" version for OSCAR very quickly and easily.....all by yourself!

Other EMR software programs require you to pay hundreds of dollars or more per form!

All you have to do to make your own eform is to go to the OSCAR site and download the 4th version of the "E-form generator".

Then, just scan your form into a black and white low resolution image and clean it up in photoshop or something - save it at about 150 dpi 8 1/2 x 11 B&W *.png image. This is pretty straightforward, and if this is beyond you - just post a request for help on the OSCAR forum. Somebody will be bound to help you out right away (this is the nature of open source software).

Now just follow the directions on the Eform Generator in order to make your form. Upload the generated forms in OSCAR (that you made with the eform generator) and start using it right away! Specific directions are on the website above. See here for instructions on scanning and preparing your images.

Now, you don't have to have numerous pads of various forms for Radiology referrals, Specialist referrals, lab form referrals, etc., etc. You just click on the form you want from the list in your patient's chart on OSCAR - and it will automatically have the patient information in it as well as your information. Just print it and give it to the patient.....or print it to the fax machine and fax it directly to the service that you want!

I created "signed" forms by signing the forms prior to scanning them.

BTW - After a few snags (like difficulty finding reliable programming people) - we're only a little ways away from getting labs done and a totally new Alberta Health Billing system done for OSCAR. The design of the billing system is being done by an Accountant/programmer....so it will be uniquely sophisticated for both insured and uninsured billings.

Stay tuned.....

Note: ipad/iPhone printing is just around the corner.....this means that you can soon use your ipad in the office to run OSCAR - and even print prescriptions from it.

Latest Status

2010-09-15T22:00:00.000-07:00

There appears to be a critical mass of interest in OSCAR going on in Alberta. Several Docs and clinics have contacted me in regard to coming over to my office to see OSCAR in action. I happily comply! So far, 5 new clinics are coming over to see OSCAR in action.

Interestingly, two of these clinics are interested in considering OSCAR in replacement of Wolf. I am therefore researching methods of helping them change from OSCAR to Wolf without too much pain. It shouldn't be too hard to do so.

The Labs module is just around the corner now....we've had to concede to acquiring another programmer to assist with this (it's 99% done, but that last 1% is, of course, the most difficult part). Part of what has made this so slow is that Calgary Lab Services and all other jurisdictional services in Alberta have now become consolidated under "Alberta Health Services". They have additionally adopted version 3 of the new HL7 data standard.

While I enthusiastically criticize the Provincial Government and all Executives in Alberta Health services whenever an opportunity arises (and many do) - I have to say that this recent decision of theirs to consolidate labs under one umbrella and data standard - has been surprisingly insightful of them! A smart decision by Government and Administrators! WTF? I pinched myself and it's not a dream! If they could only now start to grasp the concept of Provincial Health Care Worker morale - we'd be off to the races!

Maybe there is hope......

We are also going to forge ahead with this new programmer to get the Alberta billing module finished - but it will include a robustly built private billing module for the growing list of uninsured services in Alberta that Physicians must collect and keep organized for business and tax reasons.

The billing module will be anticipated to be "real time". This means that a "billing clerk" will no longer be necessary other than for periodic consolidations. The treating Physicians will simply click radio buttons on an OSCAR page to complete their billings for every office visit.

It's going to be pretty cool.

Slow but steady wins the race

2010-08-25T20:06:00.000-07:00

Ah, things are slow on the OSCAR in Alberta Development front - but at least they are methodical. The lab module should not be too much longer, and the developer is redesigning the approach to the billing module. The Alberta billing module approach will be innovative and a marked improvement on other provincial billing modules. Nice to be able to stand on the shoulders of giants!

In the mean time, I've been busy trying to create some templates for OSCAR that are Alberta specific. It isn't really all that hard with the new template generator that Shelter (a brilliant person that does OSCAR development) made. This is the real beauty of an open source project like OSCAR - it is always evolving, and so many people are always contributing that unlike any other software out there - OSCAR is "alive".

I hope to also contribute my parts to ongoing OSCAR development. These contributions range from actually getting parts made for OSCAR (and then submitting them to the CVS) to conceptual ideas.

Medicine is going more and more private in Alberta.....my colleagues that are totally dependent on Health Care Dollars are dropping like flies and closing their offices in droves. It is laughable that the "official regulatory authorities" in Alberta "have no official knowledge" of Doctors offices closing in droves. These Docs aren't bothering to inform the regulatory authorities. They're simply going totally private or are getting jobs in private clinics while doing the odd shift in a walk-in clinic (thereby not being counted by regulatory authorities as having given up practice).

It is disenchanting that our regulatory authorities are increasingly perceived as being increasingly disconnected from what is really going on in Alberta. I am convinced that there is a will to set things right, however, and innovations are happening despite poor leadership, poor regulatory authority connection and coordination and a seemingly hopelessly deficit financial situation.

OSCAR is an ideal example of what can spring out of that cauldron of boiling problems.

I should know a lot more within two weeks. So far, several other Physicians have signed on to OSCAR in Alberta....and I'm just waiting for them to get back from holidays before we get their installs going.

More soon!

Countdown to Electronic Labs

2010-05-17T22:53:00.000-07:00

Okay - we didn't "quite" pass the validation for the electronic labs. Just a minor glitch due to some slight differences between the old and the new (version 3) of the HL7 standards.

But we are well on our way. Should have everything ready for final validation within a couple of week - with the goal for electronic labs capability in Alberta being by the middle of June.

Things are going well. I have been able to make electronic forms with my own preferences using the new electronic forms generator. It is remarkably easy to use, and it works flawlessly.

I'm starting to "electronicize" more forms for my office - with the goal to having all of these forms totally electronic. It is really nice to have them printed out with the patient's demographics, and my referral comments for the referrals (ie. x-rays, etc.) very neatly typed. It is also really nice to have a copy of every referral form I have ever made for every patient - this is information not normally stored and only sometimes recorded - until now!

Vendor Lock-In and how to switch to OSCAR without pain

2010-03-13T13:41:00.000-08:00

Vendor Lock-in is bad for consumers, but good for business (not YOUR business - THEIR Business!).

What this means in terms of an EMR is that once you choose a "proprietary" EMR - you're pretty much stuck with them because of the inordinate amount of effort it

takes to leave them and switch to another.

Here is a great summary of Vendor Lock-in:

Vendor Lock-in Wiki

and

Vendor Lock-in from the Linux Folks

So - how do we make it "EASY" for users of other EMR's to switch to OSCAR?

Simple: we provide a repository of information of switching to OSCAR from other EMR's. I am going to devote a Blog with information from users that have

"done the switch" to add their contact information, wisdom and tips on how to get this done.

What I hope to eventually achieve, will be a repository of "turnkey" information and services that will allow users to switch from their current EMR's to OSCAR.

There will be a variety of posts on the blog:

1) I don't

have an EMR, but I'm cheap and I want everything for nothing - so how do I get OSCAR?

2) I am an EMR user and I'm sick of my Vendor - how do I get OSCAR?

If you are a user of any of the medical systems below - we will attempt to provide you with information on how to switch from your EMR to OSCAR (note that OSCAR has the "coolest" Logo - not an "official" logo - I just liked this one).

Click HERE to go to the OSCAR site....more coming, so stay tuned!

OSCAR for 8 months already?????

2010-02-20T21:46:00.000-08:00

Damn!

I can't believe I've been using OSCAR for 8 months already!

Sure - I don't have Alberta Health Billings working yet - nor do I have labs going yet....but OSCAR is really resulting in a significant time savings for me.

I'm still using paper charts for my Family Medicine Practice. The staff puts the paper charts in the door for me, and I use the paper charts to quickly refer to recent labs, etc. during patient visits. I make all of my notes on OSCAR on my Macbook Air.

I've learned to never type away when interacting with patients - it's just too interruptive to the process of a medical session. I take my laptop outside the room with me after the visit and type my notes.

When I don't really get time to finish my notes as well as I'd like, I simply take my tiny little Macbook Air home with me and log in to my server while in my underwear on the la-z-boy. This is much better than dragging 30-40 lb of charts home in a box like I did for years.

Alberta Health Services recently migrated to V3 of the HL7 data standard.....and so we're a little delayed getting labs into my OSCAR installation.

Looking forward to full functionality soon.

Real-life impression of OSCAR

2009-10-09T09:02:00.000-07:00

My impression of OSCAR is that it has been mostly great. Because it is the first installation in Alberta, there is essentially no billing or lab component to it at the present time.

This means that I'm really only using just under half of OSCAR's real capabilities.

Of those capabilities, there are many great things, and many things that require further evolution.

But the simple act of typing out my patient notes at the bedside works perfectly. I use a Macbook Air, which is tiny and non-intrusive between me and my patient. I also use a program called "text expander" (www.smileonmymac.com) to make notes of "block text" when I need to with the stroke of a couple of keys.

This works surprisingly well and is very efficient.

The ability to log in from home on my computer or iPhone is also a very nice feature.

The Rx creation tool is easily the best in the industry, and I can generate long lists of Rx's at least as fast as pen and paper - probably even faster and more accurate. The Rx writing tool is, however, a little less flexible than I'd like - as topical/intrasasal/intravaginal/per rectal methods of applying various meds are not straightforward to input. You have to type these directions in free text.

You can, however, save various "Free text" Rx's directly as "saved Rx's", which saves a lot of time.

The billing and lab components are being worked on as we speak - should have something ready to go by the end of the year.

We're also making OSCAR look a lot more "modern" with a consistent workflow and logic system between pages, as is the norm in many modern applications. Currently, OSCAR looks very "retro DOS" on the screen. Aart (our developer guy) has been able to modify OSCAR screens to look very modern and sleek - much like programs you see for the Mac.

THIS is the true value of open source. Once we've implemented all of this, we're going to present it to the world and make it available to all - should they find it a good thing. We hope that it will be viewed upon with favour by Jay and Dr. Chan.

The booking system for OSCAR is among the worst in the industry and my nurses *****HATE***** it. They insist on continuing to use paper to book patients...and then transcribing the appointments to the OSCAR schedule screen. Some MOA's have stated that they like the OSCAR scheduling screen - but I suspect that they work for walk-in clinics that don't really care who is booked where. Each of our patients are carefully considered in terms of where they are booked - for example, Margaret - a nice chatty 94 year old - always comes with a list of 20-30 concerns.....and can never be booked sequentially with Tom - a tortured father with a true Narcissistic personality disorder.

We are going to make changes to the Scheduling screen a very high priority - perhaps even higher than the Alberta Billing section.

Once we figure out how to do this (using the new Google Web Toolkit), I believe that OSCAR will be eventually bulletproof.

The next month is going to be very exciting for OSCAR.

OSCAR is finally installed in my office!

2009-07-09T23:43:00.001-07:00

We've done a "high end" renovation in my office.
We decided that we didn't like the typical "tired" look that we had acquired after no renovation or updating, really, since the mid 70's.

I think that Physicians and even Patients have become resigned to the fact that a Doctor's office is supposed to have old magazines, be dusty and in various levels of disrepair and show chronic evidence of "heavy use". It is frankly quite depressing to go to work in that sort of environment - and it makes it difficult to recruit good help and to maintain high office morale.

So we splurged. We did a "high end" office renovation. The new Receptionist desk was built around the people staffing it - for their comfort , ergonomics and security. The tops are real light coloured Brazilian Granite with copper flakes and the woodwork is all cherry. The drawers are all "self closing", and the lighting is a nice warm dimmable halogen. The counters were raised to a comfortable working level for the staff and the phone systems were upgraded with a modern PBX system that is menu-driven. Printers have been changed to wireless and have been moved across the room and have been replaced with low decibel printers. A wireless music system has been piped to a BOSE system that can be changed at any time from the wireless setup on the iMac's.

The office chairs are a supple padded rich brown leather with ergonomic contours to be easy on elderly patients' bones and the chair back rests are Brazilian Granite, so as to keep certain people from going through the wall when they sit down hard. Doors have all been replaced with solid oak.

The scent of Hawaiian Guava and Citrus blossoms drifts in subtle breeze throughout the office (got this gizmo from the US), and the new non-slip light groutless Italian slate floor tiles always look clean. The lack of carpet adds to the ability of noise and patient interaction to carry through a bit more, so we have commissioned a new "white noise generator" that will be installed in a few weeks.

What is that, you ask? It is a large wall fountain waterfall that generates a nice soothing white noise background. It keeps the office humid and will absorb voices that carry through.

On the other side of the office will be installed a Plasma TV with ongoing newsfeeds and webcams of the City at various intersections.

The new computers are all Apple 24" iMacs. I and my nurses will carry Macbook Air's into each patient room for patient assessments. A Dymo Labelwriter 300 Turbo is attached to one Mac, but all Mac's can share printers, so it is nice to be able to print a label from anywhere in the office.

The Linux servers running OSCAR are mirrored to each other and back up automatically every morning at 03:30. The servers are completely silent and have no hard drives (we're using the new Intel SSD's).

So far, the Nurses are inputting new patient demographics into OSCAR with no problems. We had to customize the printer settings a bit in order to print labels on the Dymo - but that is just a matter of tinkering. We also had to remove all the Ontario defaults (like Ontario area codes, etc.).

Soon, we'll be adding appointments into OSCAR - but we won't use it as our operational EMR until we are able to get Calgary Lab Services Data into it.....I estimate that we're about 6 weeks before that point.

For now, the ability for me to be able to dicate my notes for referral to other MD's or Consultation Notes back to referring MD's is pretty cool! I'm using MacSpeech's new Medical Dictation software with the new Blu-tooth wireless Microphone. So far my dictations are about 98% accurate - but things get better as I train the software.

Next steps: Get Calgary Lab Services Working and then get OSCAR working with Alberta Health Billings.........more later!

J.

Getting Support

2009-06-16T06:55:00.000-07:00

The developer I'm working with is using some exciting new tools (Google Web Tools) to standardize and "slick up" the OSCAR user interface....mostly for my billing screen use.....but we hope to extend this to the rest of OSCAR with the support & help of the Developer's community.

There is growing interest in Alberta in OSCAR - and a great article about OSCAR was summarized in the Vancouver Sun by Dr. David Chan on June 15, 2009.

I've approached the president of the Alberta Medical Association to look into helping me get OSCAR going - and I was impressed that Dr. Noel Grisedale responded by asking one of his colleagues up in Edmonton to look into OSCAR to see what can be done to support my efforts!

Next step is to approach government offices and an MLA or three - getting the inertia going is a little like rolling a large boulder by hand....but hopefully soon it won't be so hard!

If you build it...they will come....won't they?

2009-05-18T19:17:00.000-07:00

OSCAR work is progressing nicely.

LOTS of things had to come together since my last post.

Aart (my programmer partner) has been granted access to the main CVS trunk for OSCAR, and he has some very exciting ideas on modernizing the software to have a much more modern look & feel. We're going to immediately implement this modern "Mac-esque" look & feel of OSCAR to the Alberta Version's billing page. It's going to be very cool!

We need to build a larger user base for OSCAR in Alberta - to that end, I'm going to start my campaign through paid ads, demos and through the Drug Reps. It'll be a LOT easier for naturally suspicious Alberta Docs to have a useable OSCAR to see in demo - so I'm working hard on the UI aspect of a presentation.

Today, I bought Macspeech - which uses the Dragon Naturally Speaking engine for speech recognition input into OSCAR. I also bought the Revolabs xtag wireless USB Microphone.

I also just learned that there is a firmware update for my Intel SSD drives that I put in my new servers!

Shouldn't be too long before we have a useable version of OSCAR for Alberta. In the mean time, I'm also renovating my office. I'm building a nice new LARGE work desk for my nurses (with nice granite counter tops & natural cherry cabinets & shelving, which will have nestled "holders" for the servers and OSCAR I/O computers. We're also putting in new flooring, new examination room tables, etc., etc. Should be nice when it is done.

One could argue that I'll never recoup my investment in OSCAR or my new "high end looking" office. But not everything is about money. It's also about how you feel when you go to work. My office environment will now be something closer to what you see on the TV show "Private Practice". It's nice to feel good about the work environment.....the Chinese have known this for 1000's of years.

I'm also buying the new Xerox multifunction printer, the 4260XM. It's expensive, but works like a hot damn for faxing, receiving fax to email/ftp and copying/printing/scanning (in duplex).

More soon.....

Some progress on Alberta OSCAR

2009-05-11T19:04:00.000-07:00

I haven't updated in a while. To date, my developer, Aart has been very busy and has visited both Vancouver and Toronto to learn more about OSCAR development procedures and to get welcomed into the developers community.

I now have a key fob and password to test our Alberta Billing Module on Alberta Health Service's test server - and we're going to see if we can't get something going over the next month.

The billing interface will be common to all Provincial billing interfaces across Canada - as we would like to not redundantly reinvent the proverbial wheel.

On the practical side of things, I am going to get a 15' Macbook Pro and install Parallels on it with Windows XP to run Dragon's Natrually Speaking speech recognition software. I'm going to use a Plantronics Blu-tooth wireless microphone to dictate - directly into the fields of the firefox browser that I'm also going go run on the Parallels-nested Windows installation.

Why Windows? Well -the only reason is because it is the only OS for which Dragon's mature software is available. Once it is available in its full form for Mac OS - I'm going to have a little burning party to burn any and all of my Windows OS CD ROM's!

Hopefully, it won't be long.

I now have two mirrored servers that run Solid State 32 Gb hard drives and which consume only about 6 watts of power! These servers are deadly silent, deadly cool an deadly fast!

The investment in the new intel Solid state x-25 drives was expensive - but absolutely worth it!

I'm planning on being able to use an "Alberta Version" of OSCAR at the Family Medicine Forum in October.....the pressure is on!

To date, my "free open source software experience" has cost about $10,000. Good thing I don't have any other expensive vices!

The First Alberta OSCAR Users Group Meeting

2009-03-15T23:12:00.000-07:00

Well,

The first Annual Alberta User's Group meeting is scheduled to take place at 10:00 a.m. at the Grand Wailea Hotel in Maui, Hawaii on March 19th, 2009.

It looks like there will be only one attendee this year.

Features of this year's OSCAR experiences will be conveyed by interpretive hula.

Hopefully there will be more attendees next year.

Oh, for Fork's sake!

2009-03-15T22:55:00.000-07:00

I just learned that OSCAR development isn't something as simple as getting/hiring a programmer to make the changes that you want.

This apparently results in something called a "forked" version of OSCAR. Forked versions are generally considered "bad" by open source groups.

In fact, I've learned so far that by doing things without the involvement of the OSCAR development in general....I would be considered a bloody, no-good "motherforker"!

Not wanting to do that, I found a list of the officially accepted development process for getting OSCAR modified. I've done most of the initial steps...and have discovered that the "critical"step (step "f") needs me to find funding.

I tried the AMA, the POSP, the Primary Care Network, Alberta Health, etc.....but nobody wants to fund it (although they all think that it is a good idea).....so....I'm going to "Self" fund this with my own money. Hopefully I'll find a way to get it back one day. We'll see if the kids can tell whether or not they're eating generic Kraft dinner......will know if the cat disappears....

I also had to learn what a "PLONE" site was....this is an important aspect of OSCAR development.....I STILL don't know what the heck a Plone site is.....but I'm going to watch the video (click on the link). I think that I'm going to feel very smart after I watch the video...

Next steps are to acquaint my programmer with the development community.....

What's new

2009-03-03T00:06:00.001-08:00

While I haven't blogged...I've learned a LOT.

I met with a really good guy who is a very talented and "high level" programmer. He patiently spent some time with me to open my pea brain to the "real scope" of bringing OSCAR to Alberta.

Current tasks that I've started on:

1) Filling out the Alberta Health H-Link paperwork to get a key fob so I can access the Alberta Health test server for the billing module.

2) Filling out the Calgary Lab Services paperwork so I can do the same thing to get HL7 lab data into OSCAR

3) Met with "Da guy" that is capable of doing this whole thing

4) Emailed my accountant to see if I can fund this project personally under the new CCA (Capital Cost Allowances Program) with CRA that will hopefully allow me to deduct 100% of hardware & software costs until Feb. 2011.

5) Had another look at my hardware requirements: I'm going to postpone all of that and play with OSCAR on the Programmer's server (he installed it!).

6) Restarted the process of getting part B done on my PIA (Privacy Impact Assessment). Part A is complete. The PCN (Primary Care Network) will help me with this.

More soon!

The Roadmap to getting OSCAR going

2009-01-29T22:46:00.000-08:00

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.....

I want OSCAR - what now?

2009-01-24T13:46:00.001-08:00

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 (oscarmcmaster-bc-users@lists.sourceforge.net). 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.....

On deciding upon an EMR (Electronic Medical Record)

2009-01-18T15:39:00.001-08:00

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!