USA version of OSCAR?

A group of physicains are looking at developing a USA focused release of OSCAR.

While their website (servedoctors.com) seems to be more focused on selling stethoscopes, they do list a product called “ServeDoctors EMR v1.1” for release in Feb 2004.

As found from a posting on the OSCAR forum at: http://67.69.12.117/oscarForum/viewtopic.php?t=59

I would like to invite doctors and programmers to post their thoughts about necessary changes for OSCAR to be used within the USA.

Please spend some time using the demo at http://67.69.12.117/index.php?pageId=3 and then post your opinions or suggestions.

These are some of the major goals that USA developers have for OSCAR right now:

>> Integrated USA billing module that will act as a data clearinghouse for OSCAR for various private insurance billing and medicare/medicaid

>> Symantic and quantitative tracking adaptations. For example: Some lab values are reported with different units in Canada vs. USA. Most symantic changes are fairly easy to make, but we need more feedback from USA doctors regarding any terminology that appears to be abnormal

>> USA typical templates. OSCAR has the flexibility for you to change the templates on your particular installation with no programming knowledge required. In the near future a whole library of USA ready templates will be available as an add-on or import into the standard OSCAR installation.

>> Enhanced progress note/encounter documentation features. The main enhancements here are: integration of flow sheet usage into encounter documentation, providing better vital signs tracking, and USA typical physical exam.

If you are a programmer in the USA who is interested in helping enhance OSCAR, please contact me [ troy@servedoctors.com ] so that we can collaborate and be more effective working together instead of apart.

Hospitals examine open source approach to records

Interesting “article”:http://www.itbusiness.ca/index.asp?theaction=61&lid=1&sid=54474&adBanner=eGovernment by Scott Foster in ITBusiness.ca: …An increasing number of medical centres in Canada and abroad are turning to an Ontario-made open source tool that pools “anonymized” patient data across secure Web sites worldwide.

First developed by Dr. David Chan in Hamilton, Ont., the Open Source Clinical Application & Resources (OSCAR) is being touted by some in the medical community as an online reference tool that improves critical diagnostic and therapeutic decisions made daily by medical practitioners.

For example, if a patient is pregnant and has diabetes, the caregiver can link to OSCAR to access the records of patients who fall into the same category, explained Joseph Dal Molin, founder of the Open Source Health Care Alliance, following a presentation on OSCAR last month at the Children’s Hospital of Eastern Ontario (CHEO) in Ottawa. In doing so, physicians can base all treatment decisions during the entire pregnancy on what�s been done in the past by other maternity experts, he said.

While the concept of placing patient data on the Web may raise the ire of some privacy watchdogs, Chan said the software system covers its bases.

Significantly, the OSCAR team was recently part of a wider research project where data was pooled into a central data repository, or CDR, “through a secure portal to protect transport and access,” said Chan, an associate professor of family medicine at McMaster University. “All patients participating in this research have signed a consent form and understand how (the) data is used.”

In the instance where on-call emergency doctors have remote access to OSCAR�s patient data, ER staff can actually “reduce unnecessary diagnostic testing and visits to the emergency room,” said Chan. His team�s current approach to this use of OSCAR is to have patients “own” the data and decide whether to release this information on an emergency basis, he said.

OSCAR�s trove of patient data is recognized only by a unique patient ID called a “research study identifier,” explained Chan. No other identifiable information is attached to the clinical record, he said, and there is a proprietary encryption box to protect the transport of data over a secure network.

A recent report by an OSCAR working group acknowledged that “most of the provided OSCAR tools were not built with security in mind.”

Accordingly, the group emphasized “strong encryption whenever possible (OpenSSH) for internal and external communication as well as a general usage of local firewalls (Pfilter) both on the master node and on the regular nodes provided.”

This, they believe, represents a “secure clustering solution.”

The team�s assessment comes as one Internet expert in the medical field recently predicted that patients would soon be able to access their records online, much like they access their electronic bank statements.

“All of this will happen in the next five years. It’s not that far away at all,” Dr. Eysenbach, senior scientist with the University of Toronto’s Centre for Global eHealth Innovation, told an audience at CHEO. “The Internet will be used at every stage of health-care delivery.”

Meanwhile, OSCAR is attracting international attention.

Eight Brazillian programmers have recently joined the OSCAR team and a Portuguese version is now available. A recent check by Chan indicated nearly 3,000 downloads of the software had been made by medical practitioners in Canada and abroad.

A community health centre in Vancouver recently began using OSCAR, with a rural group practice in Pemberton, B.C. and an area birth centre expected to come online in a month or two, said Chan. The Vancouver Coastal Health Authority has given “serious” financial support to the OSCAR team to implement an open source solution in a number of participating clinics in the Vancouver area, he added.

Open source software such as OSCAR encourages user groups to tailor the program to their needs by making code submissions to the team that created it. In the open source community, code writers need not worry about proprietary restrictions. The object is to create new improvements on existing applications in an open environment with no restrictive licensing issues.

Dal Molin said this approach could never exist in a commercial setting. If private companies established a network of academic experts and pertinent research, it would not be objective or credible, he said. It would also put the participating group of experts in a compromising position.

“The open source approach is non-threatening in that sense because it doesn�t have any conflict of interest issues,” he said.

Comment: info@itbusiness.ca

TORCH-2.0.0-alpha2 Released

Today “Open Paradigms,LLC”:http://www.openparadigms.com announced the first “broad release” of “TORCH2”:http://sourceforge.net/projects/op-torch/. This is version 2.0.0 alpha2 of the new adaptation of the electronic health record software.

TORCH is a content management application specifically designed to manage personal health record information. Using this approach TORCH avoids the stale data and context problems that are exhibited by purely relational systems after years of service.

The latest content management technology in TORCH allows it to store the appropriate data in the appropriate storage whether it is object based or relational. The direct, field level connectivity to traditional relational databases also gives TORCH access to data stored in coding and drug databases managed by other applications.

In addition to these interfaces, direct connectivity is being built in so that charges generated by EHR activity will go directly into the SQLedger accounting package. While TORCH1 supported the Open Medical Billing System (OMBS), TORCH2 will support both the OMBS and FreeB, the first open source billing system that does not require a clearing house. FreeB is currently undergoing certification in California with Medi-Cal.

In concert with the alpha2 designation, this version of TORCH is not feature complete. The interfaces from TORCH1 for drug, billing and coding are being re-worked for TORCH2. The reason for releasing this version for wide distribution is to demonstrate the consistent user interface that is compatible with US Government Section 508 Accessibility Requirements, the W3C-WAI Requirements and all browsers including PDA’s and Phones.

In addition to the new UI, the content object (template) creation process is radically different from TORCH1. While it is much more flexible and provides greater access to the system it does require the development of content object definitions on the file system. We anticipate putting a lot of effort into training the content developers on how to create these templates so they are functional and sharable between clinics. The ability for advanced system users to develop these content objects is key to the widespread appeal and adoption of this application. According to the primary developer, Tim Cook; “This is where the user community contributes back into this project and where it makes this application expandable beyond the competition.”

Due to the nature of building on a solid open source foundation. TORCH2, even though it’s designated at an alpha stage, is a very reliable application. The infrastructure for TORCH2 is running hundreds of websites worldwide. TORCH2 is appropriate for small – large practices in a single or multiple locations. It would be an ideal base on which to build a rural community healthcare network. Once the initial costs of installation and training are paid, there are no ongoing licensing fees to budget. No licensing tracking to manage. The only additional costs would be for customization that is either paid for locally or from the original developer(s).

Software development, mailing lists, support issues (bugs) and file distribution services are hosted by “Sourceforge”:http://sourceforge.net/projects/op-torch/

The documentation efforts are hosted by Open Paradigms,LLC. “http://www.openparadigms.com”:http://www.openparadigms.com

For more information about TORCH2 and it’s deployment timeline please refer to the “Open Paradigms,LLC website”:http://www.openparadigms.com or contact “Tim Cook”:mailto:tim@openparadigms.com?subject=TORCH2Release

Medical Email Company Goes Open Source?

This one may take some more research or maybe a reader from Oz can shed some light? The Australian IT is carrying “this story”:http://australianit.news.com.au/articles/0,7204,8719609%5E15321%5E%5Enbv%5E,00.html about the newly formed Argus Foundation. The thing that concerns me about the importance of this announcement is this statement: *Argus is an email client designed for “health strength” messaging over the internet. It also supports HL7, the health communication standard for security and privacy.*

Linux on the Desktop

The Linux as a Desktop movement is gaining ground. Capital Cardiolgy Associates is one healthcare company that has traded in it’s Windows desktops for Linux ones. This story on “Yahoo! News”:http://story.news.yahoo.com/news?tmpl=story&u=/bw/20040213/bs_bw/b3871118mz063
is a followup to the “report here on LMN”:http://www.linuxmednews.com/linuxmednews/1067958820/index_html last fall. Some of the numbers seemed to have changed but this move is apparently a success.

New Inpatient Sign-out System

I’m working on an open source sign-out system primarily for inpatient teaching hospital services. The goal is to augment or replace the paper based sign out in use by the majority of hospital residency programs to improve patient care. Features include a coverage system, roles, attending functionality, and dynamically generated PDF sign-out lists for those who just can’t let the paper go. Find out more and try it out here.

Medical gives FreeB and OpenEMR greenlight

FreeB the only medical billing system available under the GPL, has just passed a major milestone thanks to the OpenEMR Project. A X12 file generated by FreeB has passed the tests to be accepted by Medical. This is a pretty huge step since the Medical process is pretty difficult to navigate, and Medical is a very important payer in California. My thanks go out to the OpenEMR guys!! Maybe I can convice Igancio to give me my own topic now…

HealthCare Informatics Takes Notice

Healthcare Informatics has an article on Nine Tech Trends in healthcare, one of which is Open Source. Good to see that they are waking up to what Linux Medical News readers have known for almost four years. From the article ‘…Healthcare providers, notoriously slow to try emerging IT solutions, have begun to take notice of open source, and some have embarked on projects. “We’re in the embryonic stage now. Open source is just starting to get visibility,” says Tim Cook, president of Open Paradigms L.L.C., South Fulton, Tenn., and developer of Torch2, an open source electronic health record and practice management application. “This is a burgeoning movement that has been going on for quite a while and will continue to grow as more IT professionals learn about it.”

OIO integrates R for statistics, translated to German and Italian

With the release of OIO-1.0.8, clinicians and researchers can design web-forms, author clinical/research
workflows, schedule events, and generate reports that include
statistical routines from R (www.R-Project.Org) all through the web-browser.

With the new LiveOIO CD distribution (remastered from Knoppix), it is a self-contained, bootable system
that includes all components (R, PostgreSQL, Zope, Linux etc). This is
the fastest way to try the OIO system and also to install it. It even
includes German and Italian translations for the menues.

  • Brief Summary with Screenshots
  • Download of LiveOIO iso image and OIO source code are available under the
    GPL free software license (http://www.TxOutcome.Org).

    As always, feedback and comments are sincerely invited.