Brief Overview: Everything you wanted to know about OSCAR, but were afraid to ask
Download a printable pdf version of this page
OSCAR is a Free/Open Source Software (FOSS) product. This means that the software can be downloaded freely by anyone and the source code is distributed with the software so that peer review and collaboration can take place. For a 2 minute mini demo see: http://tinyurl.com/d93e6c
The vast majority of doctors using OSCAR choose to pay to have OSCAR installed, and to pay for support. There are several OSCAR support provider companies, and as the demand for OSCAR continues to increase, there has been a predictable market response, with an increase in the supply of support providers. For a partial list of OSCAR support providers see: http://www.oscarcanada.org/support
USER BASE: As of May 2009, OSCAR has a user base of 700-800 clinician users across BC, Alberta, Ontario, Quebec and PEI. The largest numbers of users are in Ontario and BC. The true number of Canadian users is probably higher than this, but because physicians can self-install OSCAR, there is no formal central register of users. OSCAR has experienced a fantastic year of growth in 2008, which saw a 75% increase in new installations year/year from 2007. Growth looks to be equally rapid for 2009.
HISTORY: In 2001, the OSCAR project was started by the Department of Family Medicine at McMaster University with the objective of producing a state of the art web-based EMR to support diverse academic and clinical functions. Since 2001 OSCAR has been implemented in large and small clinics across the country with most users found in Ontario and BC. An increasing number of support companies provide services which include server installation, maintenance, and user training and support.
OSCAR COMMUNITY: OSCAR support companies and users form a close knit community with regional and national group meetings. The OSCAR Canada User Society spearheads the community development of the product. Currently, OSCAR is updated twice a year, in April and October. The Roadmap Page on the OSCAR Canada web-site keeps the community informed of all the upcoming features. OSCAR is based on a community driven development model. Current contributors to the OSCAR project include:
- Large institutions (e.g. McMaster, McGill & City of Toronto)
- Independent companies (e.g. OSCAR support companies)
- User Groups (e.g. OSCAR Canada Users Society)
- Independent clinics and individual doctors
STANDARDS, CONFORMANCE AND FEATURES: In Ontario, where a standards-based approach was taken to EMR selection, OSCAR has easily passed all rounds of Conformance testing, including the most recent and rigorous CMS Specification v3.0 from OntarioMD in February 2009. OSCAR is able to communicate via HL7, can export data as mandated by the OntarioMD standards and can import labs. Oscar has an Excelleris interface for lab download and is in the process of completing its interface with BC’s Interior Health Authority’s Physician Office Integration program so that Regional reports can be directly downloaded. OSCAR can be run ASP or non-ASP.
The BC OSCAR UserGroup has managed the implementation and development of OSCAR in BC. While OSCAR fully meets conformance with the most recent and rigorous Ontario standards, there are 2 elements of BC PITO conformance that OSCAR users have chosen not to develop: upload of core dataset to centralized Ministry database, and upload of office emr CDM flowsheets to the BC Ministry’s centralized CDM toolkit database (although OSCAR can export CDM data to the Ontario Diabetic Registry).
OSCAR has excellent Chronic Disease Management Flow Sheets for Diabetes, Hypertension, CHF, COPD, asthma, HIV and INR, as well as Chronic Disease Management audit tools. The CDM flowsheets are also customizable for each patient to assist in improved tracking of appropriately customized care for each patient. There are also Maternity Care forms, reports and audit tools, as well as Preventive Care and Immunization Modules, Enhanced Prescribing, and many other features.
OSCAR also interfaces with an interoperable patient controlled health record: MyOSCAR. This was jointly developed with Harvard and MIT. For details see: http://myoscar.org// . For a mini demo (with Seinfeld opening) see http://tinyurl.com/ckuoob
OPEN SOURCE: OSCAR is FLOSS (Free libre open source software). The licence is the General Public Licence which ensures that OSCAR is available for no charge, in perpetuity. The licence also specifically gives rights to people to develop and distribute the software. Since the creation of the Linux operating system in the 90’s, open source software has grown dramatically and has clearly established its viability in the commercial sector. Because contributions to enhancing the code come from many sources in an environment of collaboration, innovation is more rapid. Open source is much more consistent with a true free market approach than proprietary products that entail the infamous 'vendor lock-in'. For FAQs about open source see: http://tinyurl.com/dy6usb
VENDOR LOCK IN: Vendor lock in means that once you have invested data in a proprietary system you are stuck. The vendor can name their price for additional features because no-one else can write for the product. New features are usually slow to arrive because the vendor has to wait until there is a significant demand for that feature before investing money into developing it. The vendor has little interest in creating customized features for one user because it is more difficult to maintain support. Before purchasing a proprietary EMR solution, ask your vendor if you will require a special password in order to extract, into a generic format, your full and complete demographic and medical record data. Ask that vendor if that special password changes on a regular basis, thus requiring you to maintain a monthly support contract with them in perpetuity. OSCAR is a fully open platform. Your data is, and always will be, your data.
STABILITY: OSCAR is highly stable. Running on Linux servers means that the server operating system is also stable. Servers run for years without the need to be rebooted and OSCAR crashing is virtually unheard of. New versions are tested for stability prior to release in the McMaster teaching clinics. The software developers have a program of twice yearly releases every April and October, with clear outlines for users in advance, of what each new release will contain. The OSCAR vendors update their customer’s systems with the newest versions.
COST: Because OSCAR is OPEN SOURCE, the software is free and there are no licensing fees. The licence is the General Public Licence which ensures that OSCAR is available for no charge, in perpetuity. The licence also specifically gives rights to people to develop and distribute the software. Because OSCAR is a browser based EMR, it can run on very low cost workstations.
Hardware costs for OSCAR:
Per Computer and screen: $600 - $1500, can be Macs and PCs
Server: $1800 - $2500 depending on size of clinic
With OSCAR and Ubuntu pre-installed with surge protection and battery backup.
Info on costs of off-the-shelf servers: http://tinyurl.com/dmek4g
Back up server: $600 - $1900 depending on size of clinic
Software costs for OSCAR: FREE
Network IT support: $0 - $400 per month. If you can keep all your computers at home connected to the Internet, you can keep your clinic running without the need of professional help. It’s that simple.
Server support: typically $300 per month for 4 docs and $50 per additional doc (or about $900/doc/year)
Additional:
Printers - $100 - $150 each for laser printers. Most users have one in every room, but this is not a requirement.
Switch/hub - $65 for small office to $250 for a large office.
Router - $65-$100.
Scanner - $500 - $1000 depending on speed and quality of scanned images
Network cabling. Local electricians usually charge $50-$100 per ‘drop’ i.e. per run of cable.
Time for IT installation and training: 7 hours @ $85/hr = $595
Of note: The “industry” lifecycle for computer hardware is 3-5 years, not because the hardware is broken but because the operating system (e.g. Microsoft Windows) is constantly being upgraded and has larger hardware requirements.
OSCAR uses only the browser function of the computer so does NOT require frequent updates to the operating system or to the hardware. It is possible to get 10 years out of hardware. This might not sound important, but is actually a BIG cost to EMR.
Cost Amortization for a 4 doc office:
$4800 in terminals …………………….amortize over 10 years so $480/year
$750 in servers ($3000/4 docs)………………amortize over 5 years so $150/year
$3600/year in server support for 4 docs…………………………….$900/year
So per doctor per year in a 4 doctor practice using decent hardware the cost is around $1600/year. With additions such as printers/switches/cables/fax machines etc this can go up to $2200/year per doctor.
The cheapest possible with say 8 doctors using cheaper hardware could be as low as $800/year per doctor.
If you search the internet, the “accepted” cost for an EMR seems to be $10 000 - $12 000 per doctor per year.
Cost is only a small part of the consideration. The functionality of the EMR is worth far more (one or two less patients per day works out to a lot of money lost).
Users agree that OSCAR has all the functionality of any of the proprietary EMRs, and in some areas does more.
TESTIMONIALS: http://www.oscarcanada.org/about-oscar/what-users-say-about-oscar/
Sue Harris: Past Head of Family Practice, BC Children's & Women's Hospital & BC Family Physician of the Year 2008
“Over the last 9 years I have had personal experience with three different electronic medical records. There is no question in my mind about which provides the best options for a family practice office. OSCAR is firstly a patient-centered record which provides evidenced-based care in a cost-effective manner which is not intimidating. Given that software is free and service charges are much less, OSCAR provides ongoing savings for those who are committed to an EMR. There are also OSCAR options for the patient to access parts of his or her own chart. In addition, OSCAR is flexible and can be altered readily for new guidelines, practice recommendations and fee schedules. Finally OSCAR is built on a community of practice: physicians across the country sharing a common goal: to provide high quality care to patients through communication and working together. This is a model for the electronic age and OSCAR should be considered by any family physician looking to an electronic health record and new way of practice.”
To read more testimonials or to find out more about becoming part of the OSCAR community see
www.oscarcanada.org
