Saturday, March 13, 2010

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

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:

and

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).









Wolf Medical SystemsOptimed Software CorporationABELMed Inc.Applied Informatics For Health Society
Practice SolutionsJonoke Software Development IncIntrahealth Canada Ltd.AlphaGlobal iT Inc.
EMIS Inc.xwave HealthcareYork-Med Systems Inc.
CLINICARE CorporationP & P Data Systems IncMicroquest Inc.Osler Systems Inc.
Healthscreen Solutions Inc.Nightingale Informatix Corporation



Saturday, February 20, 2010

OSCAR for 8 months already?????

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.


Friday, October 9, 2009

Real-life impression of OSCAR

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.

Thursday, July 9, 2009

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.

Tuesday, June 16, 2009

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

Monday, May 18, 2009

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.....


Monday, May 11, 2009

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