Before addressing the clinical and business benefits, I have learned over the years that there are still a lot of misunderstanding and myths about the the whole idea of Personal Health Record. Here is a list of common objections and my arguments for using MyOSCAR:
(1) I don't want my patients to see all my record
You don't have to if you don't want to. MyOSCAR is a different record outside of your OSCAR record. Patients don't have access to their records in OSCAR. You provide a copy of anything you think would benefit your patient, or if a patient requests for it.
(1b) I don't want to see all the stuff my patients record, or records from other providers (like naturopaths!)
This is similar to (1). You don't have to read anything if you don't want to. It's there if it is helpful - like patient's home BP monitoring. MyOSCAR is the patient's record, owned and controlled by the patient. You don't have any legal responsibility in making sure all the stuff there are accurate or useful. It's no different from patients coming in with a spreadsheet of their BP readings.
(2) I don't have time to check all the emails from my patients
Patients cannot contact you if you don't give them permission. You get to choose who can contact you and if you think the patient has abused that privilege you can remove that privilege anytime you want (I have only done that once over the years). The patient will get a message "You don't have permission to contact this provider" when he/she tries to contact you. You choose to give permission to someone whom you think would benefit from having this method of access. I have found that I have fewer phone calls if patients can write me via MyOSCAR. I decide when and where to return their message. I get on average 1 to 5 messages a week.
(3) What about legal liability if you write something down and patients act on your advice? Or if you send patients their reports and patients misunderstand the results?
This is no different from offering your advice face to face or by phone. Apparently about 40% of phone conversations are never documented in the chart. It's your word against your patients. If the conversation is clearly documented, it tends to be better thought out, with references from reliable sources, and patients have more time to digest the advice. You also provide opportunity for patients to clarify your advice further if necessary.
(4) I don't want "frequent flyer "patients to fill up all my appointments
Again, it's a privilege you give to your patients for online booking. Our clinic has chosen not to post any restriction but your clinic can decide who, when, what kind of appointments, which (participating) provider, how many appointments etc.
(5) Many of my patients don't have a computer or Internet access
Most of them do and they are quite computer/Internet literate. In many situations it is the caregiver, or the Power of Attorney who will gladly manage the MyOSCAR account on behalf of the patient.
(6) It is too expensive and who is paying for it
MyOSCAR is free(!). Well, the cost of using MyOSCAR is fairly low even if you are not the techie, do it yourself kind. Patients are quite happy to pay for it according to the many surveys we have done.
Well, once you have "disarmed" your colleague with great arguments above, you can then present these benefits, starting with business, then clinical. Many of these have fairly good supporting evidence.
(1) Online Self Booking will save you money
At least one university health service is banking on reducing one receptionist position because of this feature. My patients will be very happy not to have to be put on hold (sometimes at the back of a queue of 25 callers at 8:30 in the morning!). I don't have experience with this but our surveys suggested that patients are willing to pay for this service!
(2) Secure messaging can be a revenue stream
This is a difficult one especially if you are on a Fee-for-service style practice. For a capitation type practice, studies have shown that secure messaging can reduce the number of office visits, or enhance the quality of a visit if prior communication via secure messaging has taken place. More about this under clinical benefit below. Again, surveys have shown that patients are willing to pay for this service. In the United States where supply exceeds demand for family practice, patients are willing to switch family doctor if one will provide secure messaging service!! One of the commonest type of messages I get is medication renewal. Although I don't charge patients (I have a capitation type practice), I have seen other clinics charging a fee for every medication renewal by phone. Likewise, you should be able to charge a "processing fee" for making copies of patient's record or forwarding test results with an annotated advice message. I have considered the MyOSCAR service as a "block fee" for individual, or a family.
(3) Installation and maintenance of MyOSCAR can be as easy as you like
If you can't provide technical support you can always out-source it; or if you don't want to install your own MyOSCAR server, you can send your patients to another MyOSCAR host out there. Once again, I think patients are very reasonable, they will be happy to pay for the service with support included. This is not for everyone in your practice. It's about a choice offered to your patients. I can now enroll a patient at the end of a visit with just a few clicks in OSCAR. I print the registration letter which includes the patient's username and temporary password and instruction of how to login. I can decide whether the patient can or cannot communicate with me right from the registration screen. There are more and more self-support Youtube videos to help patients using this service.
(4) There will be Apps (potential revenue sources as well as evidence based clinical management for patients)
MyOSCAR is a perfect platform to launch Apps. The Online Booking is really part of the Clinic App. The Clinic App can stream (RSS feed) from your clinic site important information and announcements right to the patient's MyOSCAR account. Patients can pick Clinic specific functions, such as Booking Appointments. The idea of a Clinic App is that patients can interact with the clinic at the clinic level.
There have been many Apps going through their study phases:
- MyBP - hypertensive patients managing their cardiovascular risk factors with the help of a small group of professionals (pharmacist, dietitian, and a nurse practitioner).
- MyMEDS - medication monitoring of effectiveness and adverse reaction
- eDiabetes - screening of patients at risk of developing diabetes
- eAAPS - electronic Asthma Action Plan System
- BORN - antenatal care
- ORN - Ontario Renal Network managing Chronic Kidney Disease
- Chronic Pain - managing chronic pain
- HealthLink - managing complex patients who are using huge amount of health resources
- TAPESTRY - keeping patients healthy at home
- I-am--able, I-am-pregnant; these are some of the previous studies that used MyOSCAR as a platform for communication, patient entering their clinical status; and patient executing self-management care plans.
(5) Asynchronous secure communication can improve efficiency and outcomes
It will not be immediately obvious in the beginning but I have found a few particular situations where clinical benefits are quite immediate:
- Home bound patients: it will save a few home visits and even home visits will be briefer
- The sandwich generation will be the most grateful. I have looked after many complex geriatric patients with the children communicating with me via MyOSCAR. They are usually middle age professionals who would appreciate keeping in touch without taking time off. These busy professionals also happen to be parents with children in need of quick advice
- Some mental health patients require frequent follow-ups. MyOSCAR will reduce the need for 30 minute counselling. Patients will learn self monitoring of symptoms and side effects of medications and feedback can be done "virtually".
- Patients going through tough time can benefit from improved access and communication. These are patients going through cancer treatment, or after hospitalization.
- This is a particularly great forum to include allied health professionals in coordinating care with very complex patients (e.g. chronic pain or patients with multiple co-morbidities).
