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?

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?

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?

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

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….

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