The technology behind MyOSCAR is based on the Indivo project from the Harvard-MIT Children’s Hospital Informatics program (http://www.chip.org/research/ping.htm). The origins of this project are found in the team’s 1994 publication (the Guardian Angel Manifesto), in which it was proposed that health information software move away from complete control by doctors and hospitals and focus more on the individual. The Manifesto argued that because current health information systems were “built for the convenience of health care providers,” the patient’s records tended to be fragmented, and were sometimes incomplete, incorrect, or inaccessible. The vision was to develop software that would help track, manage, and interpret the patient’s health history.
These concepts evolved over the next decade, as did the innovative software that was developed as a result. In 1998, the team began developing portals, or programs allowing patients to view portions of their electronic medical record. Then, in 2001, the focus shifted to software that enabled patient control. Originally called PING, IndivoHealth is the world’s first personally controlled record system, a free, open source application built to public standards.
The principles that guide development of patient controlled records were written in a 2001 BMJ paper:
- Electronic medical record systems should be designed so that they can exchange all their stored data according to public standards
- Giving patients control over permissions to view their record (as well as creation, collation, annotation, modification, dissemination, use, and deletion of the record) is key to ensuring patients’ access to their own medical information while protecting their privacy
- Many existing electronic medical record systems fragment medical records by adopting incompatible means of acquiring, processing, storing, and communicating data
- Electronic medical record systems should be able to accept data (historical, radiological, laboratory, etc) from multiple sources including physician’s offices, hospital computer systems, laboratories, and patients’ personal computers
- Consumers are managing bank accounts, investments, and purchases online, and many turn to the web for gathering information about medical conditions. They expect this level of control to be extended to online medical portfolios.
The architecture that achieves this vision was described in a 2004 JAMIA paper.
In 2002, the Department of Family Medicine at McMaster University in Hamilton, Ontario, Canada launched OSCAR (Open Source Clinical Applications & Resources), an open source software project designed for the delivery of evidence-based resources and decision support at the point of care for both patients and providers. Applications included programs for office automation, decision support tools, and an electronic patient record. Among other things, OSCAR is a electronic medical record system that enables clinics to move away from paper-based records.
At around the same time, the OSCAR team began to develop OSCAR Citizens, a personal health record project. In the process, they learned of the open source Indivo project and decided to join the Indivo team. During the last two to three years MyOSCAR was developed. Also a free, open source application, MyOSCAR extends the capabilities of Indivo to operate seamlessly with OSCAR. MyOSCAR is being launched at two Hamilton clinics in the summer and fall of 2007.