Having not written a prescritpion manually for 10 years it was a massive shock coming to Canada in fall 2002. Now 5 years later once again the familiar decision support helping ensure accurate dosage and avoid interactions is back helping me prescribe more safely. The fact that it is legible and quick also helps. Like any EMR installation this was not without its teething problems. Which restaurant should we take the OSCAR team to the day they arrived was one of the main ones.
Seriously I was amazed at how quick they were. They arrived and within two hours there was a server with OSCAR ready to roll. Of course the staff have to learn how to register patients, make appointments and generally get familiar with the system and all this takes time. Doctors are just starting to use the system clinically and again there is a learning curve. However I have learnt something from three EMR installations I have run in the past and the advice to use it only for a couple of consultations per clinic to start with, so that one builds experience without stopping clinical workflow, has proved invaluable.
So we have a an EMR at minimal cost. It works, and does what we want, and because its open source if there is anything we want to improve we can change it albeit with some helpful programming support.
Have there been any nasty surprises? No
Does it do what we wanted? Yes
Am I satisfied? Very
However the real proof will be in 3 months when my target is to have had over 1000 consultations recorded by clinicians. My second target is that within 6 months 50% of consultations are recorded electronically and by 1 year 90%.
Chair Family Medicine
January 09 update
OSCAR has now been running at the Queen Elizabeth Urgent Care Clinic since May. With over 20,000 patients now registered on the system we have cracked that process. Fourteen doctors are using the system and have made more than 8,500 clinical note entries and over 1,000 prescriptions. We have nurses doing triage on all our patients and two months ago started using the system for that. With 500 patients seen per week about half of all consultations are now paperless and the number is increasing. In this high volume high pressure clinic this is truly amazing. We have now scanned in one of our shelves (18ft) of charts and no longer are worrying about running out of space. All the charts of the doctors who are still using paper charts are being scanned. It is all a gradual process. The primary aim was to keep the clinic running smoothly and to achieve 50% electronic data entry in this setting within 7 months was a major accomplishment.
We have one satellite office working out of the three potential sites within the group and we hope a second will come on line in 1 week. The satellite unit has switched their appointment system to OSCAR and now is scanning the charts to become paperless. One of their users is entering data using a tablet PC with handwriting recognition.
So having proved to ourselves that OSCAR works – as a family doctor I always have to see the drug work in my patients before I really decide to use it – I am now encouraging our three Montreal teaching units to adopt OSCAR. St Mary’s hospital family medicine unit are the most active and we hope will be asking Jay and David to deliver one of their preloaded systems in a month or two. Then there will be the Herzl and finally the Cote Des Neiges site. There are hurdles as these sites are inside government hospitals ( I know – why should a family medicine unit be anywhere near a hospital) with there own IT systems. However if we can crack these then there is no end to expansion.
Oh – and in case you want the French version Jay is setting up a test version in the next few days on our server. Some beta testing and then we will be asking our Francophone colleagues to join the OSCAR party. They have some pretty neat decision tools and information resources that will be an excellent add on to the system.
Dr Martin Dawes