OSCAR in Alberta: the real deal

I was initially very excited to get OSCAR working for my busy combined medical and surgical clinic in Calgary. The “OSCAR Community” is always helpful with great advice from experienced people, and is an excellent resource.

But what to do when you ACTUALLY want to get stuff done?  How do you go about it?  How do you get OSCAR installed in Alberta, get it working, get support, training, Alberta Health Care billings and Labs?

How do you acquire and configure a server?  How do you assign port forwarding, as well as a static IP addresss for your clinic?  How about a PIA statement so that you can have an EMR?

What if you want to switch from getting totally screwed from Wolf or any of the other numerous proprietary software vendors?

What to do, and how to approach wrestling this monster?

Relax!

You don’t need to know any of that stuff.  You just need to know who to call and you need to expect to pay about $250/Mo for a turnkey solution.

Yes, OSCAR is “open source”, and it can never really get bought/sold/go out of business.

That’s already in the bag.  All other medical software vendors can and will lock you in.  It is part of their business model that they completely control the client-service relationship.  Using a proprietary EMR vendor disadvantages the Physician by requiring them to assume all risks responsibilities and liabilities in the relationship between Physician and Vendor.

Doctors should never submit to controlling and predatory relationships like that.

This is why an open source solution like OSCAR makes the most sense for Doctors.

So is OSCAR free?  Yes.  It is free - much like it is free if you personally scrub your office floors and answer your own telephone lines to book patients.  In the meantime, replace the oil in your car, change over your summer tires to winters and service your fridge when it goes on you.

But your time is too valuable for things like that unless you find one of more of those things to be a pleasantly distracting hobby.

You hire people to take care of the logistical tasks associated with your practice.

Your EMR is a very important and complex practice tool.  Too important and complex for you to mess with on your personal and professional time.  Society at large wants you doing patient care work, not scrubbing floors, fixing cars and fridges or messing around with computer stuff.

Nobody wants a Doctor to be late or a no show because they could not get their car started.  Standards are increasing for Physicians, and EMR's are rapidly becoming necessary tools for Physician to keep increasingly complex patients medically organized and appropriately attended to.

So you need an OSCAR vendor that can takrncare of all the details for you.

That’s the “Easy Button”.  All you need to do is to push it

Two current solutions for getting OSCAR in Alberta:

1) Sign up for JUNO.

JUNO is OSCAR, but they are not an "officially sanctioned" OSCAR Vendor.

In my opinion, this is no big deal in regard to JUNO.  The fact is that the larger Canada-wide OSCAR community that came up with the "officially sanctioned" OSCAR idea, tends to focus on the needs and wants of BC and Ontario OSCAR users.  This is not surprising, as that is where most of the user in the country reside.  But I've been trying to get OSCAR in Alberta since prior to 2009 with no luck at all.  I have to say: JUNO eventually came through and created not only a killer lab module for OSCAR, but also a killer billing module for it.  They also tend to solve any OSCAR problems that pop up from time to time - right away -.  JUNO is not a "fork" from OSCAR, but rather an immediately deployable solution in my opinion.

My experience with JUNO is that they just get things done and rapidly solved without politics, delay or hiccups.  This is critical in an EMR, and at the end of the day, I just don't have any patience for the "OSCAR POLITICS" that seems to have developed in the OSCAR community at large from the perspective of an Alberta OSCAR user.


2) Sign up for NERD

NERD is an excellent OSCAR service Provider for OSCAR in Alberta.  Problem is that they don't, as of yet, have a working Alberta billing or lab module for OSCAR.   If you like, they can possibly arrange a special agreement with JUNO to provide billings/labs through a separate agreement.


Whatever you decide to do, at least you have above some practical solutions that you can employ to get OSCAR working and ready for your Medical office in Alberta.

Feel free to email me if you have any concerns or questions.

Happy Alberta OSCAR User

OSCAR persists as the best of the best for Humanistic Medicine

Wow!

It has been a bit of time since I last posted anything on OSCAR in Alberta!

Lots has happened!

I have been approached by several new EMR software vendors that intended to start operations in Alberta.  I have been asked to evaluate their software and to comment upon my opinions.  This was exciting because in my opinion - more competition is good for everybody!

The software that I reviewed was overall pretty innovative, but in my opinion - overly "templated", which in my opinion takes away the incredibly valuable "human component" of the record of patient interaction.

"Template" EMR's also increase the risk of factitious or erroneous information and  - while tempting to use - do very little to contribute to quality patient care.

There is really no value in "template" records in EMR software.  One would think that recording a ream of "pertinent negatives" (that were never "really" checked on) would minimize medical-legal risk.  That is totally untrue.

Colleges and even Lawyers are now educated enough about "template" EMR records, that "template EMR's" have become a risk for liability in keeping EMR records.  Template EMR records are a big stinky red flag for College investigators and lawyers (all smart people), that suggests that you are more interested in "efficiency" than in quality medicine.

This is ironic in Alberta, where Government seems to often prioritize "efficiency" over "quality" in medical care - but you have to let Government sort through this all to eventually get it right.  In truth, Government will ultimately take inspiration from the Physicians that actually DELIVER health care.

The fact is that we "SET THE TONE AND STANDARD OF QUALITY" in medical care, and we cannot afford to get lulled into accepting low-end, robotic recordings of a Physician-patient interaction (found in many EMR's).

I recently took a course on Humanism in Medicine.  I went into the course, feeling a bit cynical at my role in Medical Care, and frustrated with the fact that I am spending more and more of my time as a patient advocate - battling anything and everything run by Alberta Health Services - than actually practicing my profession.  Not that Alberta Health is the "enemy" - they just have the impossible task of increasing demand for dwindling resources.  The potential for conflict between Patient advocates (Physicians) and the Administrators of these resources (Alberta Health) is inevitable under the current  administration of health care.

The course on Humanism in Medicine simply rocked my world.

I was "reintroduced" to Medicine as wonderful combination of Art and Science that defies adequate explanation.  I was "reminded" to return to the "humanistic roots" of what drove me into this wonderful career in the first place, and shown how I had become drawn into bottomless pit of the "Race to the bottom line" that has become the mantra of Provincial Health Administrations in Canada (and of Health Insurers in the USA).

The fact is that modern medical care requires Family Physicians to be tireless, fierce and proud advocates for their patients - without regard to income, consequences, pressures, doubts or fears.

So when I returned to practice with my newfound resolve to practice "humanistically", magic happened!

I still got paid.  I still got tired, I still got frustrated.  But I was way happier.

My patients felt better cared for and I no longer romanced plans for retirement or a switch to another career.  I'm not making as much as I think I should - but I don't spend money like an idiot and I pay my bills, save for retirement and can afford bully sticks (damned expensive) for my little buddy, Higgins (emotional support puppy who works in our office to calm down kids and other patients in need).

This is Higgins

Oops.  I digressed!

What I was getting at, is that "template medicine" has no place in a Physician's EMR.  One can make small templates that remind one to question a patient about certain important items - ie. depression in a postpartum check, etc.  But "pre-filled" templates are irresponsible and probably unprofessional in my humble opinion.......and in the opinion of smart people in the "know" (see here).  Even the Colleges agree (at least the CPSA does in Alberta).

OSCAR remains template-free in its essence.  One can make custom templates, but they have to be "made" by you - and they can be made and used as a tool to jog ones' memory.  The "toiletpaper roll" in OSCAR where one records their "SOAP NOTES" is old school, effective and captures your impressions as a Physician.

I have learned to dictate into my SOAP notes "live" by using my MacBook Pro to auto-type as I speak.  I speak my impression and lots of ancillary observations into my OSCAR notes using the voice dictation features available through any Mac OS (Windows has this too).

This is done in front of the patient, and I include notes about the patient illness experience.

The gratitude and completeness that the patient feels with this approach, is considerable.  I also occasionally offer to print a copy of the office visit for loved ones in cases where the patient's memory may be past its "best before" date.  ;-)

Very, very few EMR's allow this kind of "natural" interaction with patients that is facilitated by the EMR.  In fact, most EMR's actually discourage this - wanting to instead have us act like robots.

Perhaps this is why OSCAR is really taking off in Alberta.  I am excited to witness more and more consultation requests coming into my Office Surgery Clinic daily from OSCAR users in Alberta.

The success of OSACR in Alberta is probably driven by the old "slow and steady wins the race" mantra.  The Government support of Physicians adopting EMR's (POSP program) is now gone.  This means that Physicians are getting fleeced by their EMR companies (ie. Telus's WOLF EMR) for low-end EMR's that encourage "low end", "robotic" EMR interaction.

Not OSCAR.

OSCAR remains the EMR of "Humanists", and it seems that a growing number of Physicians agree!

More soon!


ps.   Oh!  And those EMR companies that I evaluated?  All gone.  No responses from anybody.  No marketing, no follow-up interactions.....nada......their profit models are broken.  That is why OSCAR will likely be the "last man standing".  It is not owned by anybody - there is no "profit model" for OSCAR.  You pay a good vendor to take care of you  - and then you just take good care of your patients.  What better model for an EMR could there be?


Feel free to comment on your questions, concerns and criticisms!

Is the open source nature of OSCAR dying?

A recent letter has been circulating:


And I quote the letter here:

I am concerned about the future of Oscar. There are a few recent issues which everyone who cares about Oscar should be aware of...

1) Back in April 2016, Oscar-EMR was 'reorganized', but apart from the people at Oscar EMR and the new people who have taken over, no news has been released.

I was told that a news release would be coming soon, but it has now been over 2 months with nothing.

For better or worse, Oscar EMR was made into an important piece of the community and their decisions affects all of us. Now that radical changes are happening, the community is being completely ignored.

2) MyOscar development has been directed into a new MyOscar3, which is now called Kindred PHR and is a complete re-architecture of MyOscar.

At the last FMF meeting, I was told that the new pricing structure was $10 per month per physician and free for patients and administrators.

Now, after migrating a client from MyOscar2 to Kindred, we find out that the rates are $50 per FTE per month. Reading the fine print, it also says that membership is for "a trial period" with no indication of what it may cost in the the future.

At this point, the original myoscar code is available but not being developed and the KindredPHR code is not available at all.  So much for Open Source.

3) The Annual BC User Group meeting has been cancelled, as well as our presence at the upcoming FMF. I understand that these meetings take time and planning, but there should be enough people in the community to help organize these events.

4) I saved the best for last. The McMaster Legal Department has asked some OSPs to cease using the 'Oscar' name unless they become members of 'Oscar EMR'.

How much? No prices are listed publicly and the only known members are the larger Oscar EMR 'Charter OSPs'.

My take:

Essentially, Oscar EMR has been taken over by a group of OSPs who are now preventing other OSPs from using the word 'Oscar'.

Before making any more assumptions, I think the community should be made aware of the changes and key decisions being made without their knowledge.

The entire reason why Oscar was made as an Open Source project was to prevent it from being hijacked by anyone or any group.

Now, Oscar EMR, with the help of McMaster, are taking control of the Oscar name and threatening legal action and fines if a non-approved member uses the word 'Oscar'...

Where is OCUS? Why is there no public response to these radical changes?

So - bottom line: IS OSCAR NO LONGER GOING TO BE "OPEN SOURCE"?

END QUOTE (of the letter)

My take:

It all depends upon how you define "open source".

I have little doubt that there are highly tech-savvy OSCAR users out there that will defend to the death that OSCAR remains open source.

But I'm just a Physician user who wants a rock solid EMR that won't go out of business and which won't hold me hostage for "upgrades or else....", etc.

OSCAR pretty much delivers on what I want out of an EMR, but quite frankly - development of OSCAR appears to have progressed towards numerous iterations of OSCAR across the country.  My own installation is an odd mix of BC's OSCAR and Ontario's OSCAR.....with an Alberta Billing/Lab module strapped on for good measure (it is the best in the business, so I'm happy with it).

While OSCAR is working well for me for now - I am painfully aware that it is not evolving from the perspective of an unsophisticated user.

Sure, OSCAR development has "released" new versions of OSCAR (I think that they are at version 16 now) - but few users are installing it because the "debugging" process is still suffering from an undisciplined and informal approach that leaves new versions of OSCAR potentially risky for a mission critical office tool.

I am already at a point with OSCAR that lots of its functionality is just not working on my installation.    Simply being able to enter immunizations for HepA/HepB or Gardasil, for example, are just not possible (you have to enter them as "custom" vaccinations), and this has not improved since 2009.   I could go on....

One would have thought that things like this would have been improved within 7 years, but that does not seem to be the case.  Perhaps these items are improved in the latest version of OSCAR - but it is insufficiently tested to the point that it is not worth the risk of installing it  - at least to me.  For now.

Having said this, I am aware that some installations of OSCAR in BC and OSCAR in Ontario appear to have fixed the parts of OSCAR that they don't like.  There are therefore at least TWO forks of OSCAR that I am aware of.

My OSCAR installation is potentially third fork!

Hopefully, the concerns I have addressed above will eventually be addressed - but I'm not holding my breath.  I am therefore going to consider looking at alternatives.  It kills, me - but I can't afford not to.....



I shall report back -  I don't think that any better solutions exist......most other EMR's in Canada really suck compared to OSCAR.....but stay tuned!  And wish me luck!

A slight divergence to talk about how I use OSCAR and my thoughts on Technology.....

I tend to be an early adopter of new technology.  I always like to personally assess technology to see if it can be incorporated into my life or my office to make life easier.  Sometimes it works - and sometimes it doesn't.

It is ALWAYS fun to try, though.

In terms of how to better use OSCAR, I have found that the single BEST way to use it is through a wireless network on a Macbook Air.  It just works.

I DID try to use a Yoga 2 Pro, running the new Windows 10 - just to keep up with the world of windows.....it was a miserable experience.  It mostly worked - but it just wasn't slick, and ended up wasting a LOT of valuable time.

I'm not a Mac evangelist by any means....I just value my time, and Windows 10 wasted a lot of it.

I suspect that windows users would never really notice how terrible their computer experience is until they try a Mac for a week to accomplish the same tasks.

Very, very few would be willing to go back to anything windows.

But I digress:  The Macbook Air is "the" way to use OSCAR in the office.  It is small an unobtrusive, and lets you dictate or type or use "text-expander" to take notes while the patient is talking to you.  There is an art to doing this unobtrusively - and I am still trying to improve my technique.....but I would say that most patients now don't think that they computer is "in the way".

Most importantly, you can close the clamshell of a Mac to walk to the next patient room....then open it in the next room....and you are back in business immediately with no delay.

Try doing that on a Windows machine!  NEVER works smoothly, and often logs you out.  Wastes a LOT of time.

Another thing I have recently tried, is to use my new iPad Pro.  Natively, it just "mostly" works....but for "mission critical" work like this, "mostly" is far from the mark.  So I thought that this was a "no go".....until I gave Parallels a try.

Parallels Access allows you to use the iPad Pro as a remote control for a desktop or laptop upon which you are using OSCAR.  This basically lets you turn your iPad into a desktop upon which you can run OSCAR, and it will print prescriptions, email, take voice dictation input or pen input, etc. without even a tiny stutter in performance.

It is so good that I may just no longer bother carrying my Macbook Air with me from room to room anymore.

I can also run neat apps on my iPad, like Essential Anatomy: this lets me show patients in "peel away" views, exactly which muscle is the problem with, for example, "Piriformis Syndrome", etc.

Overall, the implementation of these very nice "off the shelf" technological levers has been very beneficial to delivering the "medical care experience" in the office.  Patients feel included and well-informed.

Someone once said to me that patients take home about 10% of what you tell them, but they will remember 75% of what they see and 200% of what they feel.  We therefore take great pains to let them know that we actually care about them in this increasing "race to the bottom" our Politicians are forcing upon us to service the myth of "universal health care".

This iPad app allows patients to help to "see" what is going on with the various mechanical issues that can go wrong with a body.



So - where have I failed in my zeal to try technology in the real world?

The Apple Watch:  it has the "cool" factor for about a day, and then you fantasize about hurling it off a bridge.

I don't say this lightly.  I LOVE technology, and I love to see where it can fit into my life and work.  But the Apple Watch is FAR too ahead of its time.

The bottom line?  The Apple watch DOES NOT WORK.

It can't even tell time without a lot of fuss and bother.

Technically, the little accelerometers inside the Apple Watch, calculate according to a fuzzy logic algorithm, whether or not you just did a wrist flick to tell the time....or whether you just decided to "talk with your hands because you're a little bit Italian".  It gets it right about 90% of the time.

And THAT's the kicker.  A watch that is less than 100% reliable is a fail, no matter HOW you try to excuse it.  And all the cool little apps that you can buy for it?  They don't work (bottom line).  Sure, you can tap the face of your Apple Watch to open an App.....but then you need to go for a coffee, have lunch with your wife, see 10 patients, etc. before you can actually interact with the app.

Yes, I'm exaggerating (a bit).  But it takes at least 20-30 seconds for many (or most) of the apps to open and to start working.  This makes them 100% useless.

Oh - and try to take a pulse for 30 seconds with the Apple watch!  The screen turns off in 6 seconds.  You can probably modify this in the settings - but then your watch will stop working in a few hours because of lack of power.

Oh - and you CANNOT use an Apple Watch if you are a Physician.  Evidently, nobody in Cupertino has ever worked more than 8 hours in a day (or less if you count the 10 daily breaks for Latte's).  If you work a 24 hour call day, you have no hope of having your Apple Watch make it through with you.

You MUST charge the Apple watch for hours every night or it will simply cease to function.

I have concluded that the ONLY purposes of an Apple Watch are to

1) Save its own battery at the cost of literally everything else.
2) Make you worry about saving its battery at the cost of everything else.

I danced out of the Starbucks to the dismay of its caffeine-addled occupants after having sold my Apple Watch for the price of $800 (I paid $1200) to the "lucky dude" who made the offer on Kijiji.

Back to my old reliable mechanical, self-winding, waterproof to 300m, shock and freeze-resistant, with a second hand that never stops "normal" analog watch that I will never take off again.


And if anybody even THINKS of making an OSCAR App for the Apple Watch........

How to get OSCAR in Alberta

I have been asked a couple of times about how many clinics in Alberta are using OSCAR.

The answer is: about 6 clinics now.  There are also several Optometrists and a growing number of Specialist clinics that are making the switch from Wolf and other EMR's to OSCAR due to a host of frustrations with the proprietary EMR companies.

So how do you get OSCAR installed into your clinic in Alberta?

There are several ways to go about it.

Feel free to email me directly at drjohnf8@gmail.com and I'll get you pointed in the right direction.  Don't worry - it's easy.

One last item:  if you want an e-form made for your clinic (labs, x-ray, a history form, etc.) - just drop me an email.  I have a smart young Engineering Student that would love your business.  He's cheap, reliable and thoughtful.


JF

Alberta Labs and Billings are working perfectly

I have been real world testing OSCAR labs and the billing module for some time now.  A few beta issues were discovered and have been addressed.  The system is now working perfectly and is very reliable and robust.

OSCAR is also evolving, and a rewrite is being done to keep it super modernized.   I am looking forward to seeing some of the cool things hat they come up with.

In day to day practice in the Family Medicine and surgical clinics, OSCAR has helped to reduce admin costs, increase efficiency and it has assisted me with dealing with complex multi system patients and to coordinate and integrate health care services across a broad spectrum.

My income has increased by using OSCAR quite significantly and I am looking forward to leveraging OSCAR to further increase quality and access to care for patients with even further increases to practice income.  

I hear lots of gripes from other Docs regarding their EMR's - but I have no doubt that those gripes would disappear if they switched to OSCAR.  

Alberta Lab Module just about here! Panelling patients - the NEXT BIG THING IN HEALTH CARE!

It looks like the Alberta Labs Module for OSCAR is just about here!

This is exciting news.  OSCAR-Alberta already has the best billing module available in the country.  Combine that with this new Labs module - and you have one kick-ass piece of EMR hardware.

The approval process with Calgary Lab Services just has to clear a last hurdle and we are off to the races!  Immediately, we will be able to act upon a new concept in EMR use called

"panelling".

Panelling allows us to group patients into subsets for analysis.  This allows us to increase the efficiency of delivery of health care in a timely, sensitive and innovative manner.

I know....blah, blah, blah......I sound like just so many of those amazing statements that just say nothing.


But this is different.

Let me explain to you the value of panelling via a world class, open source EMR like OSCAR:


Paneling has allowed me to increase the quality of care for my patients while simultaneously increasingly practice revenue.

Through paneling, I have been able to determine which patients are due for Complete Medicals, which patients are eligible for Complex Care Plans, and which patients are due for certain medication reviews and renewals.

My office is able to recall such patients in order to book them for necessary appointments at appropriate intervals.  Complex Care plans are performed for all eligible practice patients, and these types of appointments are scheduled throughout the year. This allows us to review and optimize patient care for complex multi system patients while increasing practice revenue for providing this service.

Paneling also serves to allows us to determine, for example,  how many diabetic patients we follow, and to determine strategies to optimize care.  This allows us to create multi-patient appointments to familiarize newly diagnosed diabetics with their condition and to talk about the initial approaches to assessment and treatment.  

These panelled groups of patients are able to form discrete cohort groups that support each other through their diagnoses and to optionally subscribe to office-managed email newsgroups for ongoing self-supportive care.  Paneling allows us to match certain groups of diabetics to each other for potential “micro-communities”.  For example, newly diagnosed juvenile diabetics (and their parents) would not be matched to newly diagnosed elderly diabetics.  One particularly successful “micro-community”, for example, is our group of newly diagnosed Philippino diabetics.  These folks love getting to know each other and to get together for “diabetic meal” potlucks, etc. and to share diabetic meal recipes consistent with their culture.

Regular appointment meetings are organized with these various micro-communities, which brings efficiency of assessment and treatment to these groups in addition to increased practice revenue.

The same panelling approach is used to identify groups of patients with other similar disease states like groups of patients with: Idiopathic Pulmonary Fibrosis, Sarcoidosis, Irritable Bowel Syndrome, Depression, Bereavement, Congestive Heart Failure, Diabetes, etc.

While the diseases make paneling of these patients possible - it is the patients’ similar disease experiences that bring them together in these types of group appointments that turn into micro-communities within the practice.

This community-based approach to creating “micro-communities” within the practice, greatly enhances quality of care and gets appropriate people with similar disease profiles and social circumstances connected.

Brokering such group patient interactions through the assistance of paneling activities increases patient quality of care on several levels, and also increase practice efficiency and revenue.

Paneling also helps us to identify patients at high risk for certain disease states.  For example, we are able to ensure recalls for patients with strong family histories of bowel cancer, renal cell carcinoma, etc.  Patients will schizophrenia and major depression are also regularly “checked on” so that these particularly vulnerable patients do not fall through the cracks in our increasingly chaotic and poorly organized health care system.

OSCAR's open source EMR allows us to harness the power of an open source format to do sophisticated panelling for our patient population.  This is better for patients, for Physicians and for the tax payer!