eHealth - David Chan
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eHealth - David Chan eHealth - David Chan Presentation Transcript

  • David Chan, MD, CCFP, MSc, FCFP Associate Professor, McMaster University November 18, 2008 Free/Libre Open Source Software (FLOSS) in Healthcare Showcase of OSCAR, A Canadian Project
  • Brief History
    • 1986 CMR (Computerized Medical Records)
    • 1989 MUFFIN (McGill University Family Folder Information Network)
    • 1999 Y2K problem at McMaster
    • April 2001 MUFFIN passed Conformance Testing for Ontario’s Primary Care Reform
    • October 2001 OSCAR installed at the Maternity Centre Hamilton
    • Nov 17, 2002 OSCAR in *Hollywood
    • Jan 2008 OSCAR passed Conformance Testing OntarioMD specification v2.0
  • Brief History
    • 1986 CMR -> publication and workshop in Melbourne
    • 1989 MUFFIN -> MUFFIN workshops around the world
      • 8/1991 “Hello everybody out there using minix - I’m doing a (free) operating system (just a hobby, won’t be big and professional like gnu) for 386(486) AT clones… Any suggestions are welcome, but I won’t promise I’ll implement them :-)” Linus ( [email_address] )
      • 3/1994 Linux 1.0 was released
      • 1/1998 Netscape released the source to their browser under a free software license (NPL and later Mozilla MPL were born)
      • 2/1998 Eric Raymond and friends came up with the term “open source”
    • 1999 Y2K problem at McMaster
    • 2001 MUFFIN and Primary Care Reform
  • Brief History
    • 1986 CMR
    • 1989 MUFFIN
    • 1999 Y2K problem at McMaster
      • 2/2000 Red Hat won InfoWorld’s “Product of the Year” award for the fourth time in a row
      • 3/2000 The latest Netcraft survey showed Apache running on just over 60% of the Web
      • 6/2000 MySQL licensed under the GPL
      • 8/2000 HP, Intel, IBM and NEC announce the “Open Source Development Lab” (IBM invested $1 billion in Linux in 2001)
      • 9/2000 The RSA patent expired, allowing for secure web transactions without proprietary software
    • 2001 MUFFIN and Primary Care Reform
  • What is open source?
    • It’s Free
    • Free in a matter of liberty, not price.
    • Think of free as in “free speech”, not as in “free beer”.
    • It’s software distributed with it’s source code
    • It’s software that protects your freedom to use and modify
  • How does it protect my freedom?
    • By using a Copyleft license
    • Copyleft uses copyright law to accomplish the opposite of its usual purpose: instead of imposing restrictions, it grants rights to other people, in a way that ensures the rights cannot subsequently be taken away
    • E.g. General Public License (GPL)
  • What is OSCAR?
    • OSCAR (Open Source Clinical Application Resource)
    • The 3 pillars of OSCAR are:
      • OSCAR-McMaster or simply OSCAR (EMR)
      • OSCAR-Resource (Clinical Resource Database)
      • OSCAR-Citizens, now renamed MyOSCAR - (Patient Controlled Health Record)
    • all are web-based applications developed using Open Source tools (Linux, Tomcat, MySQL, PostgreSQL, Plone, Python)
    • OSCAR projects use the GPL & the Creative Commons licenses
  • What is OSCAR?
    • OSCAR-McMaster provides tools for clinic operations (appointments, billing, encounters, prescriptions, lab, decision support, secure messaging)
    • OSCAR-Resource is a content management system with a search engine to manage a large collaborative resource database; it can integrate contributions from “” and Plone using RSS feed
    • MyOSCAR is a Patient-Controlled Electronic Health Record accessible from any compliant web-application (OSCAR, Plone portal, e-chap etc.); it is based on the Indivo project (another FOSS project) from Harvard/MIT
  • Collaboration In OSCAR
    • Peer Review & Collaboration (the gift community)
      • Team in Brazil (Internationalization and PostgreSQL)
      • Teams in Australia /Germany ( drug database)
      • MIT/Harvard ( - Personal Health Record)
      • BC Users Group (VCHA PHCTF project)
      • CAISI (homeless) project from Toronto (
      • Vendor/user community (e.g.
      • plus many others = rapid evolution of software code...
  • Example of collaboration & evolution of code
    • Maternity Centre of Hamilton (Ontario) started the antenatal project in 2001 (cost ~$15,000 funded by MOHLTC)
    • South Community Birth Program (BC) adapted the project and extended it to include birth and intra-partum records (~$10,000 by VCHA)
    • The Ontario 2005 antenatal record was available in OSCAR before the paper version was published on the OMA website ($3,000 split between 4 McMaster clinics)
  • OSCAR Web Server router Web Services OSCAR Users Groups OSCAR Resource Drugref/MyDrugRef MyOSCAR Linux Tomcat MySQL OSCAR backup PC or Mac Typical OSCAR Clinic Set-up ADSL/Cable Internet Access with Dynamic IP address
  • MyOSCAR - Concepts
    • Inversion of current approach to medical records - access and authorization control
    • Life-long record built to public standards
    • Ability to accept data from multiple sources via published standard messaging protocols
  • MyOSCAR - Concepts
    • MyOSCAR is an actual medical record, not a portal
    • It uses a flexible data model (XML-based storage)
    • It uses a multi-level security model - each record is encrypted and high granularity in access control
    • MyOSCAR is FLOSS using the LGPL license
    • MyOSCAR owners can subscribe to data updates from many sources
  • MyDrugRef
    • Social Network of Physicians and Pharmacists (Facebook for druggists!)
    • Personal filing of “aide-memoire”
    • Groupies of expert/peer assistant
    • Information available at point of care
  • Outcomes
    • Web-access of Antenatal Record
    • Data kiosk in pharmacy (eChap)
    • Patient self-management for hypertension
    • Rehab in Family Health Teams
    • Pandemic surveillance & disease registry
    • Dietitian support for teenagers
  • Resources
    • (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)
    • and