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.”
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 click here.
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 click here.
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.
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 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 Click here .
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’.
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.
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.
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.