OSCAR via the iPad - damn! Works GREAT!

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!

JF

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

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

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

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

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

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

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!