OSCAR is finally installed in my office!

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

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!

JF

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

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

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!

JF

The First Alberta OSCAR Users Group Meeting

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.

JF

Oh, for Fork's sake!

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.....

JF

What's new

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!