Web portals to revamp family practice, proponents say.

may revolutionize family medicine by allowing family physicians the ability to communicate with patients and provide medical services or advice online. They also contend that by offering more comprehensive access to health information, the Web platforms empower patients to take more control of their health, and that online doctoring will save money for both patients and doctors. The former won’t have to take time off work to see their doctor for a form or test result, while the latter will cut reception costs by utilizing online booking systems and automatic patient notification services. When doctors sign up to one of the Web platforms — such as mypatientaccess.ca, HealthConnex, mydoctor.ca or myOSCAR — their patients get access, to varying degrees, to such information as medical records, lab results and longterm health indicators like blood pressure and blood-glucose levels. The platforms also allow patients to securely email their physicians. But the services typically involve a fee, because provincial insurers do not generally remunerate doctors for the time they spend providing patients advice on the phone or Internet. For some, such fees raise questions around equitable access to health care. The fees essentially give patients the option of paying for more expedient and convenient access to a doctor, which could violate the Canada Health Act, says Mike McBane, national coordinator of the Canadian Health Coalition. “It’s an area we’re going to demand action on.” Patients who register with mypatientaccess.ca, for example, pay between $40 and $75 (the fee is set by the doctor) per email conversation with their physician. Such fees offer more value than block fees (www.cmaj.ca/cgi/doi /10.1503/cmaj.109-3815) now being charged by many physicians, argues Moe Jiwan, president of Toronto, Ontario-based Canadian Patient Access Inc., which partnered with Nightingale Informatix Corporation to create mypatientaccess.ca. “Our offering gives patients access to a suite of services never before brought forward and at a very reasonable rate,” says Jiwan, who argues that the Web platforms promote greater accessibility for patients. Jiwan also contends that econsults are rare and thus don’t limit time available for in-office visits. But they are “helpful for patients who travel a lot. One of the physicians had a patient recently email him, ‘Hey Doc, I’m in China and I’m finding that my sugar levels are all over the place. What should I do?’” News CMAJ