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Efforts by governments in Ontario and British Columbia to drag their provinces' medical records into the 21st century haven't gone well: Both provinces are embroiled in eHealth scandals that have turned the endeavour into a political poison pill.

But the doctors behind two made-in-Canada electronic record systems designed years ago and adopted around the world insist it doesn't have to be this hard.

OSCAR, an open-source software pioneered by McMaster University's school of medicine, is being used by hundreds of doctors from Prince Edward Island to British Columbia, and many more from outside the country.

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It puts patients' information on secure servers that are based in a doctor's office but can be accessed online from just about anywhere by logging on the same way one would to an online bank account. A separate sister system, MyOSCAR, lets patients access their own records online.

David Chan, the system's architect and a professor with McMaster's family medicine department, has given talks about electronic medical records across Canada and the United States, and says he doesn't understand why provincial governments haven't jumped to adopt OSCAR's technology.

"The impression of our current government agencies such as eHealth is that open-source projects ... tend to be not as professional," he said. "This is simply not true any more."

Because OSCAR is downloadable for free, the costs to implement it provincially would be relatively modest, he says - likely in the area of $20-million for Ontario, much of that going to vendors who would adapt the software to different doctors' needs and explain how it works.

He notes this system wouldn't be ideal for a centralized, single-server database - but then, he argues, that would probably be a bad idea anyway: Having millions of patients' medical information on one enormous server would be needlessly unwieldy, not to mention a privacy nightmare if its integrity were compromised.

"What's wrong with a single phone call or a fax with some verification? ... "If it's a government that holds 35 million records and somebody hacks in, we're dealing with a huge problem."

But Michael Graven, a neonatologist and bioinformatics expert at Dalhousie University, argues family doctor-specific systems like OSCAR are too limiting. Dr. Graven helped design a comprehensive health integration system, originally created by New Brunswick-based Accesstec for use in Belize that has since been commissioned by the World Health Organization for use in other countries.

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"You need the system to be capturing ... all classes of encounters, everywhere - hospitals, pharmacies, lab, radiology, outpatient," he said.

Dr. Graven estimates it would cost about $10 a patient to pay for the software and the IT training needed to implement the system.

But both Dr. Chan and Dr. Graven agree making patients' electronic records electronically accessible would transform Canada's health-care system for the better.

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