OSCAR Mini Conference 4 TORONTO

Here is a summary from Ian Pun:

Here are the take away points:

CV RISKS:

Dr. Raymond Chan , cardiologist, showed randomized trials of statins and now PCSK-9 inhibitors have shown that lowering LDL-C reduces cardiovascular risk, confirming that LDL-C is a cause of atherosclerotic disease so it beneficial to have the patient’s LDL as low as possible especially for secondary prevention.

I, Dr. Ian Pun, showed how to search for high LDL patient using my report by Template lab searching query which searches for the most recent lab value of every patient.

First I had my audience , who mostly were seasoned OSCAR users, try it out with their own OSCARs
Using ADMIN->QUERY by EXAMPLE

select * from measurements where type = “BP” limit 10;

to make sure their OSCARs had the LDL values as part of measurements.

Then they ran my lab searching report by Template (download in my google classroom https://classroom.google.com/o/OTUxNjY5MTE4M1pa , PM me for access code) for LDL > 5. Then these high risk patients could be accessed first.

Furthermore, I showed a search (requires backend SQL) to QUERY PATIENTS who have LDL > 2 and already on Statin and Ezetimide for PCSK-9 inhibitor treatment. Personally, I have found a handful in my own practice.

Artificial Intelligence:

A.I. encompasses rule based systems (like existing SQL queries in OSCAR) to machine and deep learning systems using neural nets, modelled after biological nervous systems. A.I. using deep learning provides a predictive model that is formed from training data, not based on preprogrammed rules. A.I. learns from examples, not programmed. However, a hugh quantity of quality data is needed.

Using google tensorflow , I demonstrated graphically how a simple neural net works, classifying two different populations with 2 dimensions. Simple data clusters that are simple shapes are easy to train. More complex shapes required more nodes and more neuronal layers to figure out.

Classifying my OSCAR measurement data into Hypertension, Diabetes, CV , I will train the neural net model using Googletensor flow. I graphed the relationship of A1C vs BMI vs Diabetes .

Dr. Raymond chan asked, “Patients who are outliers , do not fit the categories and have problems. How will a neural net find these?” Unfortunately, the neural net will not be sensitive enough to detect this. It can only be solved with more data as outliers may have a different unknown variable. He also asked “Is a neural network brute forcing its solution?” I would say it’s not because it doing it algorithmically and recursively to find the optimum solution from by minimizing the feedback error loop. Brute force is the computer’s way of trying every possibility and picking up the optimum solution. Neural Nets don’t try every possibility, only optimal ones.

Taking Photos to OSCAR — USERS are doing it!

I recommended every patient sign a PHOTO CONSENT if you intend to take a picture of any of their medical conditions.

I showed the two device (phone and computer) method of taking a picture to OSCAR.
Log onto to OSCAR on both devices. Go to patient eChart on computer. Go to patient demographic screen on phone.
On phone , add document, select PHOTO type, type PHOTO description and ADD DOCUMENT. The phone will show you to use the CAMERA APP. Take the picture and check on checkmark. Then click on ADD. On the computer refresh the screen and you’ll see the photo document added.

No extra apps are needed for this technique and your phone photo does not go onto the cloud storage as it is stored temporarily before it is uploaded to OSCAR.

A gastroenterologist in the audience said he uploads his gastroscope pictures onto OSCAR using USB and shows patients polyps on the computer to convince the patients to have them removed.

Tracking Labs

I showed my RbT that matches each patient the lab test request on the lab form (e.g. PSA) to the corresponding measurement received (e.g. PSA) and reports the patients whose measurements that were not found.

We talked about using ticklers and messenger to track lab results and recalls but agreed there are many potential points of failure from patient, lab and physician.

The GI doctor is concerned that when he sends specimens for pathology, he has no way of tracking the result as it comes back on the lab HL7. I told him this can be resolved with an histology eform to match with the HL7 result, However, unlike blood labs , there is no LOINC code for a histology result as it is text only and not pushed to measurement.

Vaccine coding

The Ontario government made a law starting July 1, 2018 that every physician must report public vaccines given directly to public health on-line.

I showed the vaccines have to be coded for name, lot number, location , route, dosage in PREVENTIONS. Hopefully this information will be automatically transferred to eHealth with OSCAR updates.

The present ICON system for entering vaccines is very user un-friendly.

Also, in the meantime I suggested to code vaccines as templates with perhaps later code can populate the preventions automatically

MAKE ENCOUNTER TEMPLATES for vaccines prefix with #V #
#V #Gardasil 9 HPV vaccine MERCK , N035952 10NO2019 , L deltoid , 0.5 cc, im

The complete slide presentation will be uploaded to my google classroom https://classroom.google.com/o/OTUxNjY5MTE4M1pa soon.

Ian

Slides can be found here: OSCARconf4_180614

Next Oscar mini-conference (#4) June 14,2018

Next OSCAR EMR mini-conference meeting (NUMBER 4) — Thursday , June 14, 2018 —- 5 pm to 9 pm.  Don Mills Library ( Don Mills and Lawrence , North York)
 Topics include intensive LDL reduction to reduce CV events primary and post ACS. Use OSCAR to search for your patients’ not at target LDL levels despite on statins.   Specialist consult notes.   Also, I will demonstrate my experiments on using a neural net program (Google’s Tensorflow) on OSCAR EMR database to classify patient diagnosis and treatment. I will apply some artificial intelligence techniques to OSCAR EMR.
It will be pharma sponsored so health professionals only.
Space for 40 only .     Dinner included.    Please register with Dr. Ian Pun  —   —  ianpun at gmail.com

Updated: OSCAR EMR mini conference #3 Toronto for Physicians Thursday MARCH 1, 2018 5 – 9 pm

Post-event Update:

We had a great turnout at our last OSCAR mini-conference again!

Slides from OSCAR MINI CONFERENCE #3 March 1, 2018 UPLOADED
Topics
CVDREAL realworld study. 39% RRR in HHF, 51% RRR All cause mortality. How to find your diabetes and HF patients with my RBT.
Recap of searching for patients with high PSA. My results after 8 months.
Drug Safety tips : drug search RBT, SADMANS, TallMANs
Techniques using Technology – more details on using smartphone to take pictures
EMR Reliability and Maintenance

https://classroom.google.com/o/OTUxNjY5MTE4M1pa

Hope to see everyone again at the next mini conference set around late June to early July!

Next  time,  I will show some cutting edge technologies I am trying on my own OSCAR EMR data — A.I. Deep Learning with TensorFlow and Intel Modivius Neural Net USB stick.  Stay tuned!

Ian PUN MD


We will continue with more clinically relevant EMR topics!  And we GO BEYOND OSCAR EMR!

PLACE:  Toronto Public Library – Don Mills Library  on Lawrence and Don Mills (this is the same place as the July meeting, not the November meeting)
Address: 888 Lawrence Ave E, North York, ON M3C 1P6

DATE and TIME:   THURSDAY MARCH 1 , 2018   5pm – 9 pm ; registration and dinner 5-7 pm ,   lecture 7-9 pm

REGISTRATION FEE:  FREE and free dinner is provided.

To REGISTER see details in my google classmate, please email me for an invite
https://classroom.google.com/o/OTUxNjY5MTE4M1pa

Practice Improvement:
Using OSCAR EMR for real-world evidence studies (retrospective observational studies) by searching for cohort and measurement data of actual patients in practice by using report by templates for improving quality of practice in diabetes management.
Recap of searching for patients with high PSA. My results after 8 months.

Patient Safety:
How to search for your drugs that are being warned or recalled (Black box warnings and vaccine recalls)
SAD MANS eform

Techniques using Technology
More digital photo and video techniques
How to upload videos to OSCAR (great for documenting 3D views of lesions, patient movement disorders, surgical procedures, dashcam videos etc).
How to take digital photos through ophthalmoscopes and otoscopes with smartphone
Recording video from the cameras of operating microscopes and endoscopes using inexpensive video capture equipment intended originally for video gaming
Uploading patient BP records from Omron bluetooth enabled BP monitor
Your Google Assistant (Android Phone or Google Home) can be your medical assistant.  Convert measurements. Ask for drug dosages and interactions. Ask for ICD-9 diagnostic billing codes.

EMR Reliability and Computer Safety:
OSCAR EMR reliability – computer maintenance and upgrading, backup strategies and Plan B’s. What to do if your server / Internet is down or very slow.  And what not to do!
How to avoid being victim of ransomware.  How to scan your server to make sure it is safe from hacking!
What you can do about RateMDs.com website.

This sponsored event is restricted to physicians and their immediate IT support staff only.

Please bring your own laptop / ipad to try the techniques immediately.  And your own extension cord for power. FREE Wifi provided by Library.

To register, please email me at ianpun@gmail.com (I’ll try to accommodate the physicians who missed our first two meetings but returning attendees are welcomed to come). Limit 40 attendees. so first come, first served.

More details in my google classmate, please email me for an invite
https://classroom.google.com/o/OTUxNjY5MTE4M1pa

Ian PUN MD
302-4040 Finch Ave E  Scarborough ON  M1S 4V5   416-848-7788
OSCAR EMR user

OSCAR EMR is a trademark of McMaster University. This conference is an independent user group meeting and has no affiliation.

** DISCLOSURE: This event is generously sponsored by
Absolute Health Center Physiotherapy, Website: Absolutehealthcentre.com   at  Woodside Square Mall 135-1571 Sandhurst Circle  Scarborough, ON M1V 1V2 T:416-551-1168   F:416-551-1578
and
AstraZeneca  SGLT2-inhibitor Forxiga (Dapagliflozin)
https://www.cvdreal.com/cvd-real-study.html

OSCAR EMR mini conference Toronto

Dr. Ian Pun, a Toronto OSCAR EMR user, has organized another FREE mini educational conference for OSCAR EMR users.

Here are his post-meeting comments:

Thank you to all who attended OSCAR EMR mini-conference #2 Toronto.

Gathering at the Fairview Public Library, we had a turnout of over 40 people who were delighted to meet our special guest, Dr. David Chan, founder of OSCAR.

We discussed functionality of computer text and window navigation, taking photos into OSCAR (an epiphany for a few members), google dictation, diabetes templates and Framingham eforms.

At the end Dr. Chan showed us his Know2Act Clinical Decision Assistants.

The main message from the meeting is that our physician community is made stronger by having OSCAR EMR remain open-sourced thereby easily sharing knowledge,  gaining experience and creating innovative new applications foregoing the high cost ,  bureaucracy  and inaccessibility of proprietary alternatives.

Keep the open-sourced OSCAR EMR going strong and hope to see everyone again at the next meeting!

Dr. Ian Pun

OSCAR EMR mini conference Toronto

Dr. Ian Pun, a Toronto OSCAR EMR user, ran a FREE mini educational conference for over 40 OSCAR EMR users at the Toronto Public Library on Thursday, July 20, 2017 from 6-10 pm beginning with a free Chinese dinner provided by sponsors.

There were over 40 people attending, including GP’s, some specialists – rheumatology, cardiologist, G.I. and psychiatrist.  and a handful of IT support (FHO QA) and even our long time supporter Earl Wertheimer coming all the way from Montreal.

Some doctors were interested in maintaining their own OSCAR server without OSP support.
Dr. Pun talked about templates, eforms, report by template, measurements , and gave a RbT (Report by Template) that searches keywords in the eChart. He also showed his Raspberry Pi temperature logger.  Finally, he gave the pointer that you should hashtag # important keywords in your eChart for easy searching.
Other topics discussed included computer security ( poodle SSL vulnerability ) and he tested his own hospital portal – (and it was vulnerable — LOL!!)  But of course , our own OSCAR server was patched and safe!
Many attendees were already asking for the next meeting!

OSCAR-CON Vancouver: Agenda and Slides

OSCAR-CON VANCOUVER presentation slides:

Download PDF slides

 

Next event:

  • OSCAR User Workshop UBC Robson Square – Sat June 24 and Sun 25

    OSCAR CON 2017 Topics include:

    •                Billing Workshop: Tips and tools for getting paid more for what you do

    •                OSCAR Dashboard

    •                OSCAR 15 new features and benefits

    •                OSCAR BC user input: getting your help to prioritize future developments

    •                The OSCAR Integrator: supporting Team Based Care and the Patient Medical Home

    •                The Health Data Coalition (HDC): using your EMR’s data to improve care

    •                New e–forms & workshop to optimize your e-form library

    •                Tips and tricks to improve office efficiency

    •                And much more!

    Click for detailed agenda

    Register – Vancouver:  www.eply.com/oscarconvancouver

  • EARLY BIRD registration price EXTENDED to June 20th.

MyOSCAR awarded $5.8 mil FedDev grant

By Joanna Frketich

theSpec.com

McMaster University is getting $5.8 million from the federal government to create a personal health record that will let patients take control of their information and communicate with doctors online — including making appointments.

It will also provide tips on how to live in a healthier way.

“This is a paradigm shift,” said Dr. David Price, chair of the department of family medicine at McMaster. “This is really trying to enable the patient to manage their own health and work toward wellness.”

The personal health record, called MyOSCAR, is already being piloted at the McMaster Family Practice and the Stonechurch Family Health Centre. It is a partner to OSCAR, an electronic health record created by McMaster that is used by about 2,000 physicians in Canada.

MyOSCAR allows patients to own their medical record. All health care providers can have access but the patient controls what and how much they see. It also has applications that would help patients manage chronic diseases such as diabetes and live healthily by providing feedback on diet and exercise.

“The patient role is critical,” said Kevin Leonard, associate professor in the Institute of Health Policy, Management and Evaluation at the University of Toronto and the founder of Patient Destiny, which advocates for patient empowerment.

“We don’t give a lot of information out to patients. We ask them to take on more of the burden of managing their care but we give them nothing to do it with. We need patient education and involvement, leading ultimately to empowerment and better health outcomes.”

He thinks the funding announced Wednesday by the Federal Economic Development Agency for Southern Ontario (FedDev Ontario) is a step in the right direction.

In total, $15.5 million was given out to bring together 16 private-sector, academic and not-for-profit research partners including McMaster and York universities to create the Connected Health and Wellness Project.

The project will develop software to give patients access to health records, a way to communicate with health care providers and information about living well.

York University is also creating a training program and professional standards for a new profession called a health coach that will help people manage disease and adopt healthier lifestyles.

“It is using innovative technologies that will be developed here in Southern Ontario, it will allow patients to participate more actively in management of their own health issues and, hopefully, it will co-ordinate some of the health care professionals on the team in a much better way,” said Gary Goodyear, Minister of State for FedDev Ontario.

The project goes well beyond electronic health records in that it gives patients the ability to connect with health care professionals using their smart phones. One application involves taking a picture of your meals, which would be sent to a health coach for immediate feedback.

The goal is to give patients more control over their health.

“If you have access to your health record, you can be informed as to your health condition, educated about the alternative treatments you might consider and ultimately responsible for the decisions that you make about your health and wellness,” said William Tatham, CEO of software provider NexJ Systems Inc., which is part of the project. “An engaged patient is a healthier person.”

jfrketich@thespec.com

905-526-3349 | @Jfrketich