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Free/Libre Open Source Software (FLOSS) in Healthcare: Showcase of OSCAR, a Canadian Project

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Free/Libre Open Source Software (FLOSS) in Healthcare: Showcase of OSCAR, a Canadian Project Free/Libre Open Source Software (FLOSS) in Healthcare: Showcase of OSCAR, A Canadian Project David Chan, MD, CCFP, MSc, FCFP Associate Professor Department of Family Medicine McMaster University, Hamilton, Ontario, Canada 1 QNUCM Nov 12, 2006 11/12/06 PPresentationresentation outlineoutline What is Free/Libre Open Source Software (FLOSS) What is OSCAR A Quick Tour Question & Answer 2 QNUCM Nov 12, 2006 11/12/06 ResourcesResources http://oscarmcmaster.org (please join) The Cathedral and the Bazaar (Eric Raymond) Open Sources: Voices from the Open Source Revolution (O’Reilly publisher) The Success of Open Source (Steven Weber) The Future of Ideas: the Fate of the Commons in a Connected World (Lawrence Lessig) http://en.wikipedia.org/wiki/Open_source 3 QNUCM Nov 12, 2006 11/12/06 4 QNUCM Nov 12, 2006 11/12/06 5 QNUCM Nov 12, 2006 11/12/06 6 QNUCM Nov 12, 2006 11/12/06 7 QNUCM Nov 12, 2006 11/12/06 WWhhaatt isis F FLLOOSSSS?? Source code versus machine code 8 QNUCM Nov 12, 2006 11/12/06 9 QNUCM Nov 12, 2006 11/12/06 10 QNUCM Nov 12, 2006 11/12/06 WWhhaatt isis F FLLOOSSSS?? Source code versus machine code Free as in “libre” not “gratis” (“freedom” not “free beer”) – freedom from single vendor lock-in – freedom from proprietary “non-standards” – freedom from DEATH (average life-span of most vendors)! – freedom to adapt to CHANGE: health care environment (e.g. Primary Care Reform) technology (e.g. hardware, software, and the Internet) standards (e.g. Infoway 2009: HL7, LOINC, SNOWMED-CT) new knowledge (e.g. Evidence Based Medicine) decision support (e.g. prevention and chronic disease management) 11 QNUCM Nov 12, 2006 11/12/06 WWhathat isis OOpenpen SSource?ource? Source code versus machine code Free as in “libre” not “gratis” (“freedom” not “free beer”) Peer Review & Collaboration (and the gift community) – Brazilians (Internationalization and PostgreSQL) – Australians/Germans (Drugref) – MIT/Harvard (Indivo - Personal Controlled Health Record) – National Research Council (Citizenhealth.ca) – BC Users Group (VCHA PHCTF project) – CAISI (homeless) project from Toronto – plus many others = rapid evolution of software code... 12 QNUCM Nov 12, 2006 11/12/06 EExxamampleple ofof ccollaborationollaboration && evevolutionolution ofof ccodeode Ontario started the antenatal project in 2001 (cost ~$15,000 funded by the Maternity Centre of Hamilton) BC adapted the project and extended it to include birth and intra-partum records (~$10,000 by VCHA) Ontario 2005 antenatal record was available in OSCAR before the paper version was published on the OMA website ($3,000 split between 4 clinics) 13 QNUCM Nov 12, 2006 11/12/06 WWhathat isis OOpenpen SSource?ource? Source code versus machine code Free as in “libre” not “gratis” (“freedom” not “free beer”) Peer review and collaboration (and the gift community) Copyright (or left?) and licensing (Is the GPL “viral”?) 14 QNUCM Nov 12, 2006 11/12/06 15 QNUCM Nov 12, 2006 11/12/06 16 QNUCM Nov 12, 2006 11/12/06 WWhathat isis OOpenpen SSource?ource? Source code versus machine code Free as in “libre” not “gratis” (“freedom” not “free beer”) Peer review and collaboration (and the gift community) Copyright (or left?) and licensing (Is the GPL “viral”?) Business model is a “service” model (with innovation) 17 QNUCM Nov 12, 2006 11/12/06 OOSSCACARR VVendorsendors OSCARWest.com (BC) OSCARService.com (Ontario) Whitesources (Toronto) WATERLOO-MUSKOKA TECHNOLOGY SERVICES (Kitchener/Waterloo) OSCAR USA Probably many others… 18 QNUCM Nov 12, 2006 11/12/06 WWhathat isis OOpenpen SSource?ource? Source code versus machine code Free as in “libre” not “gratis” (“freedom” not “free beer”) Peer review and collaboration (and the gift community) Copyright (or left?) and licensing (Is the GPL “viral”?) Business model is a “service” model (with innovation) Success of Linux and Apache (and the RedHat brand) 19 QNUCM Nov 12, 2006 11/12/06 20 QNUCM Nov 12, 2006 11/12/06 21 QNUCM Nov 12, 2006 11/12/06 WWhathat isis OOpenpen SSource?ource? Source code versus machine code Free as in “libre” not “gratis” (“freedom” not “free beer”) Peer review and collaboration (and the gift community) Copyright (or left?) and licensing (Is the GPL “viral”?) Business model is a “service” model (with innovation) Success of Linux and Apache (and the RedHat brand) Open Source Electronic Health Record (VistA, OpenEmed, OpenEMR, GNUMed) 22 QNUCM Nov 12, 2006 11/12/06 WWhathat isis OOSSCACAR?R? -- thethe 33 pillarspillars OSCAR-McMaster (EMR) OSCAR-Resource (Clinical Resource Database) OSCAR-Citizens (Personal Controlled Health Record) – all are web-based applications developed using Open Source tools (Linux, Tomcat, MySQL, PostgreSQL, Plone, Python, PHP) – OSCAR uses the General Public License (GPL) license, the lessor LGPL, and Creative Commons licenses 23 QNUCM Nov 12, 2006 11/12/06 WWhathat isis OOSSCACAR?R? -- thethe 33 pillarspillars OSCAR-McMaster provides tools for clinic operations: appointments, billing, encounters, prescriptions, lab, decision support, secure messaging etc 24 QNUCM Nov 12, 2006 11/12/06 WWhathat isis OOSSCACAR?R? -- thethe 33 pillarspillars OSCAR-McMaster provides tools for clinic operations: appointments, billing, encounters, prescriptions, lab, decision support, secure messaging etc OSCAR-Resource is a free/open content clinical resource database that brings evidence based practice to providers and patients at the point of care; it uses a search engine to manage a large collaborative resource database; it can integrate contributions from “del.icio.us” using RSS feed 25 QNUCM Nov 12, 2006 11/12/06 WWhathat isis OOSSCACAR?R? -- thethe 33 pillarspillars OSCAR-McMaster provides tools for clinic operations: appointments, billing, encounters, prescriptions, lab, decision support, secure messaging etc OSCAR-Resource is a free/open content clinical resource database that brings evidence based practice to providers and patients at the point of care; it uses a search engine to manage a large collaborative resource database; it can integrate contributions from “del.icio.us” using RSS feed OSCAR-Citizens provides all citizens a secure and private space to store their health records, to interact with providers, and decision support for self-care; it is accessible from any compliant web- application (OSCAR, Plone portal, chappie in pharmacies etc.); it is based on the Indivo project from Harvard/MIT 26 QNUCM Nov 12, 2006 11/12/06 WWhyhy OOSSCACAR?R? OSCAR offers a "royalty free" set of clinical applications and resources for use by health care providers and citizens in BC, Ontario and everywhere The low-cost, open source and open content approach is intended to enlist a critical mass of software developers and vendors, and content area experts, to improve and enhance both the software applications and clinical resources on an ongoing basis The wide-spread adoption of OSCAR is expected to promote and establish standards and bring in competition based on service; to bring an end to “Vendor Lock-in” 27 QNUCM Nov 12, 2006 11/12/06 WWhoho areare thethe developers?developers? The original development team worked through the Department of Family Medicine, McMaster University – Programming and Deployment – Training & User Support – User Documentation – Promotion to clinics and providers This work was indirectly funded by an IT incentive grant from the Ministry of Health of Ontario, to support the requirements of Primary Care Reform Current main developers include teams from Brazil, Australia and Canada 28 QNUCM Nov 12, 2006 11/12/06 Typical OSCAR Clinic Set-up OSCAR Web Services Web Server Linux OSCAR Tomcat backup PC or Mac OSCAR Home/Forum MySQL OSCAR Resource OSCAR ASP/Redirect OSCAR Comm OSCAR Fax router OSCAR Drugref OSCAR Citizens ADSL/Cable Internet Access with Dynamic IP address 29 QNUCM Nov 12, 2006 11/12/06 IsIs OOSSCACARR secure?secure? Peer-reviewed software development and quality control SSL to protect transport – even within a clinic User Name/Password-3 attempts lockout Remote access requires a second level authentication Intruders and remote access monitoring Encrypted database backup - local and off-site 30 QNUCM Nov 12, 2006 11/12/06 OOSSCCAARR-M-MccMMaassteterr isis OOnntatariorioMMDD CCeertifiertifiedd ASP (Application Service Provider) vs CMS Local Solution* Core Data Set Lab connectivity Drug-drug interaction Authentication and Authorization for every module System Specification v.1.1 31 QNUCM Nov 12, 2006 11/12/06 OOSSCACARR DevelopmDevelopmentent MMeetingseetings 32 QNUCM Nov 12, 2006 11/12/06 AA QQuickuick TTourour A typical day at the paperless office…. 33 QNUCM Nov 12, 2006 11/12/06.
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