Hospitals examine open source approach to records

Interesting “article”: by Scott Foster in …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.


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