- General System Updates
- Enhanced security in terms of password storage, new granular security objects, audit log
- OneID Single Sign on
- Proof of Concepts (Clinical Connect, eConsult, OMD Dashboard, CVC)
- Clinical Modules
- Master Demographic
- Enrolment / MRP
- Validate HC button (using HCV)
- New fields like Middle Name, Mailing Address (ISO 3662-1)
- Audit log button
- Contacts Module
- Updated items
- Externally administered
- Printing Imms only
- Major re-organization
- Customizations by clinic, provider, and patient
- Attachments (HRM, eForms)
- Completed status
- New fields (date received, abnormal)
- New Fields
- Rich Text Letter attachments
- New apconfig
- eForm Report Tool
- True North Imaging handler
- Persistent labels
- Master Demographic
- Hospital Report Manager (HRM)
- New Inbox and consolidated functionality
- Should not use HRM in provider inbox
- Major changes to preview screen
- Persistent preview screen for provider query
- Data Migration
- Updated to 5.0 specification
- Export by provider
- Bonus Reports have a new UI
- Customizing letters
- Local Dashboard
- New features of dashboards and indicators
- REST (new APIs for measurements, labs, dx, misc)
- FHIR Support
- Integrator (file based transfer system)
- General System Updates
Save the Date!
OscarCon in BC will be held on June 22 and 23, 2019
In Victoria at the U Vic – DAVID TURPIN BUILDING A104, DAVID TURPIN BUILDING A110
P.E.I. Medical Society wants electronic medical records system
After working with paper charts, Dr. Gil Grimes established his own electronic medical record system at the West Prince Health Centre. He believes it has given him more time to spend with patients. – Eric McCarthy
Dr. Gil Grimes says he was not “enamoured” with the idea of using paper charts.
When he worked at the O’Leary Health Centre, Grimes regularly kept important medical records of his patients on paper charts, instead of in an electronic medical record database. Grimes believes this practice, still common in P.E.I., resulted in inefficiencies and outright time wastage. A patient’s basic information would be repeatedly written down, handwriting of different physicians would have to be deciphered and records had to be physically filed.
Grimes relied on a staff nurse to keep records accurate and in order.
“The nurse was taking on a lot of work that wasn’t really nursing but was really kind of chart management,” Grimes said.
“Paper charts are a lot to manage. They take up a lot of physical space.”
After moving to the West Prince Family Health Centre in 2013, Grimes decided to switch to using an electronic medical record (EMR) system. He chose OSCAR, an open-source system originally developed at McMaster University. The system, which can be accessed online remotely through a secure login, has allowed Grimes to share patient information with other health professionals.
“Because it’s all within the electronic chart, none of it gets lost. I don’t ever lose that little piece of paper, where somebody had left a sticky note that said, ‘well next time you see him, do this,'” he said.
Grimes may be in the minority when it comes to P.E.I. physicians who have adopted an EMR system. A 2015 survey of 85 physicians conducted by the Medical Society of Prince Edward Island found that about 30 per cent used an EMR system. Of physicians Grimes knows in West Prince, four use an EMR, while three do not.
By comparison, the national average of EMR use was 85 per cent according to a 2017 study by the Canadian Medical Association.
In the midst of a shortage of physicians, the low rate of EMR usage may be taking the valuable time of health professionals away from patient care.
But there may be good reasons why physicians have not fully adopted digitization of patient records. One reason is that different EMR systems cannot communicate with one another.
As a result, with patchwork of different EMR systems used between hospitals, clinics and other allied health professionals, patient records are often still transmitted using fax machines.
Records are often then re-entered into different EMR systems.
“I fax everything,” said Kris Saunders, a family physician and President of the Medical Society of Prince Edward Island.
“I get 10 faxes a day of someone who ran out of a prescription. They call the pharmacy and say, ‘could you fax it do my doctor and they’ll fill that for me?'”
The lack of interoperability between EMR systems is a national concern. A recent editorial in the Canadian Medical Association Journal called for the adoption of a single EMR system for all primary care providers nationally.
On P.E.I., provincial hospitals have been using the CERNER system. An e-mail statement from Health P.E.I. said primary care providers use a number of systems, including OSCAR, Practimax, ISM and iCore.
Health P.E.I. began a pilot project in early 2018 for a streamlined EMR system for primary care providers. The pilot project, which has so far cost $200,000, involves a family physician’s office, a primary care network site, a home care office site and a provincial program site.
Health P.E.I. did not make available a representative to speak about the pilot project.
But Saunders believes physicians are keen to be more involved in the selection of an EMR system.
“We haven’t really seen any findings at this point that make us feel confident that this is the best one moving forward,” Saunders said.
Saunders said an inefficient or complicated system could be an even greater drag on the valuable time of doctors.
“It’s not about getting an EMR, it’s about getting the right EMR,” he said.
This is not the first time the province has attempted to establish one province-wide EMR system. In 2014, the province issued a request for proposals for a provincial EMR system. One system was put forward, with significant of support from physicians, Saunders said. But a statement from Health P.E.I. said the RFP was cancelled because the selected system “significantly exceeded anticipated costs.”
“There was one final vendor that was chosen. But after that, it seemed that there was an election time and that sort of desire went away,” Saunders said.
Despite this, both Grimes and Saunders said P.E.I.’s small size has allowed its healthcare system a golden opportunity do away with filing cabinets and fax machines.
“Even though we’ve been slow to adopt these, we could leapfrog the rest of the country and be a leader in technology. It doesn’t take much; we’re so small and nimble,” Saunders said.
Here is a summary from Ian Pun:
Here are the take away points:
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.
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.
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.
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.
Slides can be found here: OSCARconf4_180614
We had a great turnout at our last OSCAR mini-conference again!
Slides from OSCAR MINI CONFERENCE #3 March 1, 2018 UPLOADED
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
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
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.
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 email@example.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
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
AstraZeneca SGLT2-inhibitor Forxiga (Dapagliflozin)
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