eHealth - David Chan


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eHealth - David Chan

  1. 1. 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
  2. 2. Brief History <ul><li>1986 CMR (Computerized Medical Records) </li></ul><ul><li>1989 MUFFIN (McGill University Family Folder Information Network) </li></ul><ul><li>1999 Y2K problem at McMaster </li></ul><ul><li>April 2001 MUFFIN passed Conformance Testing for Ontario’s Primary Care Reform </li></ul><ul><li>October 2001 OSCAR installed at the Maternity Centre Hamilton </li></ul><ul><li>Nov 17, 2002 OSCAR in *Hollywood </li></ul><ul><li>Jan 2008 OSCAR passed Conformance Testing OntarioMD specification v2.0 </li></ul>
  3. 3. Brief History <ul><li>1986 CMR -> publication and workshop in Melbourne </li></ul><ul><li>1989 MUFFIN -> MUFFIN workshops around the world </li></ul><ul><ul><li>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] ) </li></ul></ul><ul><ul><li>3/1994 Linux 1.0 was released </li></ul></ul><ul><ul><li>1/1998 Netscape released the source to their browser under a free software license (NPL and later Mozilla MPL were born) </li></ul></ul><ul><ul><li>2/1998 Eric Raymond and friends came up with the term “open source” </li></ul></ul><ul><li>1999 Y2K problem at McMaster </li></ul><ul><li>2001 MUFFIN and Primary Care Reform </li></ul>
  4. 4. Brief History <ul><li>1986 CMR </li></ul><ul><li>1989 MUFFIN </li></ul><ul><li>1999 Y2K problem at McMaster </li></ul><ul><ul><li>2/2000 Red Hat won InfoWorld’s “Product of the Year” award for the fourth time in a row </li></ul></ul><ul><ul><li>3/2000 The latest Netcraft survey showed Apache running on just over 60% of the Web </li></ul></ul><ul><ul><li>6/2000 MySQL licensed under the GPL </li></ul></ul><ul><ul><li>8/2000 HP, Intel, IBM and NEC announce the “Open Source Development Lab” (IBM invested $1 billion in Linux in 2001) </li></ul></ul><ul><ul><li>9/2000 The RSA patent expired, allowing for secure web transactions without proprietary software </li></ul></ul><ul><li>2001 MUFFIN and Primary Care Reform </li></ul>
  5. 5. What is open source? <ul><li>It’s Free </li></ul><ul><li>Free in a matter of liberty, not price. </li></ul><ul><li>Think of free as in “free speech”, not as in “free beer”. </li></ul><ul><li>It’s software distributed with it’s source code </li></ul><ul><li>It’s software that protects your freedom to use and modify </li></ul>
  6. 6. How does it protect my freedom? <ul><li>By using a Copyleft license </li></ul><ul><li>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 </li></ul><ul><li>E.g. General Public License (GPL) </li></ul>
  7. 7. What is OSCAR? <ul><li>OSCAR (Open Source Clinical Application Resource) </li></ul><ul><li>The 3 pillars of OSCAR are: </li></ul><ul><ul><li>OSCAR-McMaster or simply OSCAR (EMR) </li></ul></ul><ul><ul><li>OSCAR-Resource (Clinical Resource Database) </li></ul></ul><ul><ul><li>OSCAR-Citizens, now renamed MyOSCAR - (Patient Controlled Health Record) </li></ul></ul><ul><li>all are web-based applications developed using Open Source tools (Linux, Tomcat, MySQL, PostgreSQL, Plone, Python) </li></ul><ul><li>OSCAR projects use the GPL & the Creative Commons licenses </li></ul>
  8. 8. What is OSCAR? <ul><li>OSCAR-McMaster provides tools for clinic operations (appointments, billing, encounters, prescriptions, lab, decision support, secure messaging) </li></ul><ul><li>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 </li></ul><ul><li>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 </li></ul>
  9. 9. Collaboration In OSCAR <ul><li>Peer Review & Collaboration (the gift community) </li></ul><ul><ul><li>Team in Brazil (Internationalization and PostgreSQL) </li></ul></ul><ul><ul><li>Teams in Australia /Germany ( drug database) </li></ul></ul><ul><ul><li>MIT/Harvard ( - Personal Health Record) </li></ul></ul><ul><ul><li>BC Users Group (VCHA PHCTF project) </li></ul></ul><ul><ul><li>CAISI (homeless) project from Toronto ( </li></ul></ul><ul><ul><li>Vendor/user community (e.g. </li></ul></ul><ul><ul><li>plus many others = rapid evolution of software code... </li></ul></ul>
  10. 10. Example of collaboration & evolution of code <ul><li>Maternity Centre of Hamilton (Ontario) started the antenatal project in 2001 (cost ~$15,000 funded by MOHLTC) </li></ul><ul><li>South Community Birth Program (BC) adapted the project and extended it to include birth and intra-partum records (~$10,000 by VCHA) </li></ul><ul><li>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) </li></ul>
  11. 11. 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
  12. 12. MyOSCAR - Concepts <ul><li>Inversion of current approach to medical records - access and authorization control </li></ul><ul><li>Life-long record built to public standards </li></ul><ul><li>Ability to accept data from multiple sources via published standard messaging protocols </li></ul>
  13. 14. MyOSCAR - Concepts <ul><li>MyOSCAR is an actual medical record, not a portal </li></ul><ul><li>It uses a flexible data model (XML-based storage) </li></ul><ul><li>It uses a multi-level security model - each record is encrypted and high granularity in access control </li></ul><ul><li>MyOSCAR is FLOSS using the LGPL license </li></ul><ul><li>MyOSCAR owners can subscribe to data updates from many sources </li></ul>
  14. 15. MyDrugRef <ul><li>Social Network of Physicians and Pharmacists (Facebook for druggists!) </li></ul><ul><li>Personal filing of “aide-memoire” </li></ul><ul><li>Groupies of expert/peer assistant </li></ul><ul><li>Information available at point of care </li></ul>
  15. 18. Outcomes <ul><li>Web-access of Antenatal Record </li></ul><ul><li>Data kiosk in pharmacy (eChap) </li></ul><ul><li>Patient self-management for hypertension </li></ul><ul><li>Rehab in Family Health Teams </li></ul><ul><li>Pandemic surveillance & disease registry </li></ul><ul><li>Dietitian support for teenagers </li></ul>
  16. 19. Resources <ul><li> (please join) </li></ul><ul><li>The Cathedral and the Bazaar (Eric Raymond) </li></ul><ul><li>Open Sources: Voices from the Open Source Revolution (O’Reilly publisher) </li></ul><ul><li>The Success of Open Source (Steven Weber) </li></ul><ul><li>The Future of Ideas: the Fate of the Commons in a Connected World (Lawrence Lessig) </li></ul><ul><li> </li></ul><ul><li> and </li></ul><ul><li> </li></ul><ul><li> </li></ul>