What users say about OSCAR

Dr. Susan Harris

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 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 are 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.

Dr. Martin Dawes

Past Chair of Department of Family Practice McGill University

How good a doctor are you? Probably if you are reading this you are interested, caring, empathic, incredibly busy, and not so well paid!

Along came OSCAR to the rescue. An accredited EMR that is free. No strings. We just bought two servers running Linux, an uninterruptable power supply, rescued a couple of old PC’s from the basement and we were in business. A day of installation by David and Jay, a day of training, and we had a fully functional record. The support group has been great with its valuable tips and some hand holding.

I nearly forgot.  We will soon be using the audit functions to see how good we actually are.

Dr. Jel Coward

Pemberton BC

OSCAR, world leading!, academic led!, free!, open-source!

5 years ago I knew the last three of those things, and I suspected the potential for the other.  Today I know them all to be the case.  OSCAR is an inspiring project, but most importantly it is absolutely the most useful tool in my clinical armamentarium. 

No-one in our office would give up OSCAR.    We had two IT refuseniks when we first talked about implementing an EMR,  within a week they had both given up writing and were merrily charting and prescribing in OSCAR.


......and now with the advent of MyDrugRef (the social networking drug information service for physicians) and MyOSCAR (a Personally Controlled Health Record) the OSCAR community is moving on into newer and even more exciting waters.

Warning:  Don't get involved in OSCAR if you don't like rapid progress!

Dr. Quentin Smith

Crossroads Family Practice, Chilliwack BC

The electronic medical record along with voice recognition software has revolutionized my practice and represents the single most significant change in my practice in the last 20 years.

OSCAR is something that I think is incredibly important in the evolution of the use of information technology with an application to the medical field in British Columbia.

In order to move ahead with modernization of my own practice, I left my previous practice where there was little appetite for the turmoil of significant change, and joined forces with another 3 physicians as of October 2006.  We became one of Fraser Health's Enhanced Family Practices. 

What happened however, was something I had never anticipated.  My new partners felt that we needed to look at all the options including open source software, namely OSCAR out of McMaster. To my chagrin, I had never really heard of or fully understood the concept of open source software.

While all the other vendors are excellent, the very principle behind OSCAR was appealing to the rest of the physicians in my group.

We implemented our system and went live in May of 2007.  While change is always hard, and we have worked incredibly hard at the process of moving from paper charts to electronic charts, I can truly say that this has been the single most important change to my practice in 20 years.  There has been a significant improvement in our workflow and efficiency, I am using voice recognition for data import into the computer, and I do not believe there is a better way to extract information when needed, than from an EMR that is well-organized and accessible from not only the office, but remote sites as well.

What has blown me away however is the culture around OSCAR. 

·    There is a very active discussion group, and the level of knowledge of computers, software, programming, programs, billing etc. amongst this group of physicians is staggering to me.  The level of support for one another, and the willingness to share fixes based on experience, creates a safe place for new users.

·    The program itself is simple yet powerful.

·    It is free.

·    The argument that "you get what you pay for" just doesn't wash in this situation.  We have not paid, and yet we have got plenty.

·    Because it belongs to everyone, everyone has a stake and there is a motivation among the group to produce improvements, offering those improvements to the entire group.

·    What really has opened my eyes is the degree of computer literacy in this group.  Combine that with the flexibility of having access to code, and you have a recipe for quick fixes.  Let me explain: Within our practice, Dr. David Page, along with one of our then residents, now locum, Dr. Shelter Lee were responsible for the creation of no less than 140 electronic forms.  Please remember that that was in just under 7 months!  These forms are

o    requisitions currently used for tests, including significant shortcuts and levels of sophistication which are very impressive, including the ability to draw electronically the site of any palpated masses on the breast mammography requisition.

o    Special authority forms

o    informational forms for the patient around processes such as mucomyst protocol for contrast use in imaging

o    a new form for the Complex Care initiative from GPSC (which was created within weeks of us beginning to perform these visits: ie. no need to wait for the next build)

§    the second generation of this form has guidelines and patient handouts embedded into it, all made from our office, and able to be shared to any other Oscar users..

o    clinical tools such as genogram, rheumatoid diagram delineating which joints are involved in arthritis, surface anatomy drawings including the ability to annotate, prostate symptom score, mini-mental, PHQ 9 depression scores, Ottawa ankle rules, and the list goes on.

o    Sick notes, referral notes to allied health professionals etc. can all be done in seconds.

o    Bear in mind all of these e-forms have the ability to automatically fill with demographics of the patient, and we can voice dictate clinical details into them should we so wish.

·    Others in the group of our predecessors had worked on the B.C. prenatal form which is excellent, and a B.C. grown INR tracking device which was also excellent.

·    The beauty of the system is that if somebody contributes an improvement, everyone benefits.  Our e-forms have been shared nationally.

·    There are of course new builds periodically, based on the usual process of user input, and those responsible for coordinating these rebuilds are people in B.C. like, Dr. Jel Coward, and Dr. Colleen Kirkham who has been a tireless champions, and from Ontario Dr. David Chan, the originator of the program. People who truly believe in the concept, and have spent countless hours of personal time simply serving others in this way.

·    On the technical side, the hardware that we are using to run this is incredibly simple and cheap.  There is nothing fancy that is required.  We have local servers which are fast and uncluttered.

·    Laboratory data that is now coming in from the Health Authority as well as B.C. Biomedical Labs electronically through Excelleris.

·    Laboratory module that is providing grid views of lab data giving one a beautiful historical view of all the tests done on the patient.

·    Diabetes care form (CDM flow sheet) and the hypertension flow sheet which is auto-populating the laboratory values.  It should be noted, that there is an appetite to attempt to produce one CDM flow sheet which will be applicable and assist in the management of each of the CDM's.

OSCAR has advanced and matured despite having very little, if any, funding.  That is an unbelievably remarkable situation.  It will continue to flourish no matter what happens in the future, because of the philosophy behind it.  I believe more physicians should be aware of this possibility, and from a funding point of view there is an awful lot that we could do with very little.

It should also be recognized that in Ontario, OSCAR was the first of any of the vendors to complete the validation execution of CMS specification 2.0 in January 2008.

Dr. Steve Adilman, Vancouver Native Health Service

Our experience with OSCAR has been very rewarding. Our clinic is a very busy community clinic in Vancouver’s Downtown Eastside. We have 4 FTE family doctors, a nurse, and specialist support each week  in Ophthamology, Internal Medicine and Psychiatry. As well, we tutor medical students and residents and EVERYONE has been very pleased with our conversion to OSCAR. We converted from paper in late November 2008 and the transition was remarkably smooth. In fact, the transition was met with renewed enthusiasm amongst all office staff. Everyone was a buzz with the new system and excited to share their insights and struggles with each other. Some of our doctors use voice recognition software and others are happy to type. Several of our physicians have used other EMRs in other locations and all have commented that OSCAR is the most user-friendly EMR that they have used. It is very robust and customizable and the community of users is dedicated to improving and updating OSCAR regularly. The online OSCAR usergroup is populated with many doctors and programmers with a wealth of knowledge who are always willing to help solve any problem we encounter. We only wish more people knew about it. Don’t be fooled by the price-it may be free, but it certainly isn’t a lesser product than any of the costly proprietary EMRs and from our experience it is better!

 Dr. Gunther Klein, Campbell River BC

I am a family physician running a “paperless” medical group practice in a small city in BC, and we have recently migrated OSCAR. Before this we had been using an expensive proprietary EMR for 5 years. What struck us all immediately when we started using OSCAR was how intuitive, easy and elegant this powerful EMR system is, and what a joy it is to use. And, since it is “open source” (just like Linux and “Open Office” for example) we were able to implement it at a fraction of the cost of our old EMR system. It also cost substantially less than the various provincially sponsored proprietary EMR solutions, even though OSCAR does not qualify for government subsidy in BC. In the last few months two other medical offices in town have also seen the advantages and have moved to OSCAR.

One of the main reasons why OSCAR is so effective is that it has been improved upon for years by its active and involved community of users, other doctors and health care professionals, who have consistently integrated their improvements for use by everyone. This is how open source works. The program does not belong to anyone, and everyone can improve it. This concept lends itself well to the field of medical practice, where the emphasis naturally falls on the collegial sharing of knowledge and expertise among the team of health professionals with the ultimate common goal of improving patient care. Open source systems eliminate the need to protect a corporate vested interest and thus open the door to unimpeded shared innovation.

It has to be noted that just because OSCAR is open source doesn't mean that it isn't a powerful and fully featured EMR suite with everything that opens and shuts. It truly is on par with all those other proprietary EMR offerings out there, and it is better than many of them. Below is my review of OSCAR based on my experience so far.


1) USER INTERFACE:

OSCAR can be described as a free text system with some structured input. It is well suited to those who do their own typing, but also works very well in conjunction with commercial speech recognition software. In addition there is a quick templates utility that allows you to pull in "canned text" macros on the fly while constructing your note. The spell checker comes courtesy of Mozilla Firefox. Any part of the chart can be exported to PDF and printed.

The patient encounter screen is clear, well laid out, reveals the patient history summary at a glance and allows easy one-click access to all the clinically relevant features of the patient chart:

There is a PREVENTIONS MODULE to allow tracking of vaccines, PAP tests and so forth. There is also a DISEASE REGISTRY with well organized electronic CDM TRACKING flow charts for diabetes and hypertension etc. The flow sheets automatically populate with relevant lab data.

An ELECTRONIC FORMS module allows you to choose from a wide selection of preconfigured e-forms, ranging from clinical tools, such as MMSE, complex care plans, prenatal and Rourke forms, to printable image versions of your local lab and x-ray requisitions, all of which auto-populate with the patient's demographics and your name (and the history - if you so choose). Many more e-forms have been built by other tech savvy users and are shared and available for easy upload from this website.

The scanned CHART ATTACHMENTS are accessible from the DOCUMENTS tab, which is searchable by type of document scanned. A nice feature of OSCAR is that it allows you to merge a number of separate attached PDF files together and open them as one.

The ELECTRONIC LAB MODULE allows you to view labs imported electronically in HL7 format (via Excelleris in BC). Labs can be viewed either by instance ordered, or in a grid or a row display. They also print in a nicely formatted fashion. In addition there is a MEASUREMENTS module that allows you to track and graph specific lab values and vital statistics over time. As mentioned above, specific lab values auto-populate the CDM flow charts.

The PRESCRIPTION WRITER module is clear and easy to use. It searches the official Health Canada database, which gets updated regularly. A "FAVORITES" side bar allows you to build a list of your commonly used meds on the fly that can then be prescribed with one click. The favorites list can be edited easily. The "ALLERGIES" tab can be used to specify a specific brand name drug (e.g. Ceclor), a class of drugs (e.g. Penicillin) or even a free text entry (e.g. Kiwi fruit). Warnings for potential drug interactions or allergies show up in colour, but do not become too intrusive (no annoying popups). Re-prescriptions can be done with a few clicks by selecting from the prescription history list. Free text notes can be added to the prescription in the print preview window and there is an option to paste a copy of the prescription right into the text case note. The print output is clear, nicely formatted and organized. You can get up to 10 medications on one prescription page.

The CONSULTATION module makes constructing referral notes a breeze, giving you a quick selection of relevant specialist organized by specialty. There are handy-dandy buttons that pull in the text from the various parts of the patient history summary as you desire. The active prescriptions from the prescription writer populate automatically. An attachment tool allows you to select from the scanned chart attachments and the electronic lab data. I do my referral letters in the exam room in front of the patient these days.

The "TICKLER" utility is unique to OSCAR and it combines the function of a recall utility with a task module. A "tickler" can be attached to a patient's chart, set to "go off / tickle" at some predetermined date in the future and it can be directed to any specific staff or provider user, or group of users on the system. It can be used for a wide range of clinical and administrative applications.

In addition to the above there is also a separate intra-office MESSAGING utility that allows for secure text messaging, either attached to a specific patient chart or for general messaging on the system.

The BILLING is well designed, in fact so well designed that we have done away with day sheets altogether. All doctors now enter their own billings from a customizable pick list that is accessed with one click from the encounter screen. The system generates billing reminders for CDM fee codes that may have been missed. The more advanced billing tasks like private third party guarantor invoices, submissions, resubmissions, remittances and financial reports are all a breeze to do. My staff members are really happy with this. Billing fee code updates are downloaded and updated directly from the medical services plan at the click of a button.

The ADMINISTRATIVE PAGE allows the administrator user to, among many other things, control the users on the system and manage password access and security, using a role based security utility that allows you to assign specific roles to specific users on the system, and then fine tune the access permissions for each role. Advanced database searches can also be executed from here.


2) TECHNICAL POINTS:

What sets OSCAR apart from most other EMRs out there from a technical point of view is that it is written in the same programming languages that the modern internet is constructed with, and that it uses secure web server technology. You access the server both locally in the office and remotely from home or hospital much the same way that you would access your online banking account, using your favorite browser, either Mozilla Firefox or Internet Explorer. This makes OSCAR remarkably fast when accessed locally in the office with really crisp response times, compared to many other EMR solutions, both ASP and local server. Accessed remotely it is equally fast on a broadband connection, but it is in situations where the internet connection is spotty and dips out periodically where it really shines. Other systems using Citrix or Remote Desktop connection protocol simply crash and disconnect in such situations. OSCAR freezes up for moment and then goes on where it left off.

OSCAR installs right in your office on a Linux server platform on two separate identical servers that run in parallel in a redundant configuration and mirror each other's information. In the event of a main server crash, the backup server can take over quickly. Servers running Linux tend to be pretty stable and almost never go down. Because Linux is an open source operating system, there are no hidden yearly third party client access license costs, payable to the major IT corporations of the world for use of their operating system technology. Those costs can easily add up to thousands per year.

Backups happen automatically every night from the main server to the back up server. The backup file is automatically compressed and encrypted and can be easily downloaded to another network drive or to a USB stick, which can be taken off-site. In addition the main server can be set up with internal redundancy using backup hard drives.

Another remarkable feature of OSCAR is that, because it uses secure web server technology, there is no need to construct a complicated "VPN" office computer network. This simplifies the networking issues immensely. It also allows the user to access the server from client computers running any operating system (PC, Mac or Linux), or even a combination of these.  


3) INSTALLATION AND IMPLEMENTATION EXPERIENCE:

If you are reading this thinking that you are going to download and install OSCAR yourself, then I should warn you that this is not like installing your average Windows shareware program. You would want to know your way around the Linux Ubuntu Server operating system and have at least a basic grasp of HTML, JavaScript, Tomcat, Python, MySQL and SSH protocol. If that describes you, then go for it! A link to the instructions is posted elsewhere on this website. If on other hand you are like me and that is all Greek to you, then I would suggest that you do what I did (and what most OSCAR users do) and enlist the help of one of the independent OSCAR technical support providers out there, the contact details to whom you will also find on this website.

I made an initial phone call, then spent some time on the Dell and HP websites choosing the servers I wanted (and marveling at just how cost effective and yet powerful even entry level servers have become these days). After deciding on what I wanted I emailed the folks from OSCARA and asked them to configure the servers with Linux and pre-install OSCAR for me. A few more emails to confirm technical details, and the servers arrived at my office via FedEx, in their boxes. I unpacked them, plugged them into my network switch and turned them on. They worked. Presto! I had a brand new OSCAR installation at my fingertips. When it comes to EMR installation, this is about as close to "plug and play" as it gets.

A few days later our OSCAR expert spent an afternoon and evening with us setting us up correctly, training us and configuring the interfaces with the medical services plan and with Excelleris for the lab download. We went live the next day. No hiccups to speak of.

Okay, there were maybe a couple of minor teething issues in the first few weeks, mainly related to the format of the demographic import file, the WCB billings and the lab upload, but nothing that couldn’t be fixed rapidly with a phone call or email to our OSCAR support provider.

In summary I have to say that the move to OSCAR has been relatively trouble free for us, almost like hitting the easy button. Other offices might have other experiences, but it seems that a lot of the problems I have encountered with other EMR products just don't seem to exist with OSCAR. It clearly has been refined to the point where all the big issues have been dealt with. We now have a superior EMR product.

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A WORD ABOUT MARKETING:

Another striking difference between OSCAR and all the other EMR products out there is the very noticeable lack of marketing with OSCAR. At first glance OSCAR might seem a bit less polished than the other products out there. This is because nobody is spending any money on things like corporate image and a sales team. So don't be scared off if you don't see a glitzy website or a flashy demo. Every dollar raised for OSCAR goes directly back into improving the actual program functionality, and this is where the polishing counts after all.

Gunther Klein

River City Medical Clinic

Campbell River, BC