1. In MyOSCAR, each user is a unique user with authentication requirement whenever he/she wants to access his/her MyOSCAR account. This is really important as all the privacy and confidentiality framework hinges on it. Each user is given a "role" but this role is used primary to change the user interface to facilitate workflow. For example, a patient will want the UI to view his/her record, access secure messaging, and determine sharing rights. A provider has exactly the same data backend but the health record part is essentially meaningless. His/her UI will make it easier to navigate all the contacts with patients. All transactions are logged in the system as legal documents within MyOSCAR. By using OSCAR, we try to eliminate the need to login to the MyOSCAR provider interface. We let OSCAR UI do all the usual transactions with patients without having to open up another browser window and login as a provider. Besides, we want OSCAR to have copies of all the transactions (i.e. messages and record of downloaded documents). That's why in theory MyOSCAR can be deployed in practices not using OSCAR, or not even any EMR at all - but it will require extra effort and the performance of the provider UI in MyOSCAR is quite a lot slower than OSCAR which is optimized for speed in a typical clinic environment. I hope this is clear because everything that follows requires that you understand this point.
2. Subscription agent is a concept that gives facilities (or any data repositories) the ability to push data into MyOSCAR accounts. Typically a patient applies to the hospital to have hospital records automatically downloaded to his/her MyOSCAR account. The hospital is responsible to authenticate the patient. This is usually done face to face checking some kind of photo id, after which the patient must login to his/her MyOSCAR account to give permission to the hospital as the subscription agent. Once authenticated, the hospital will enable some kind of a "flag" in the patient's record to begin daily download of hospital records belonging to that patient. So this has nothing to do with OSCAR. When we talk about hospital downloading data to OSCAR, we do so in batch following our separate discussions. So if the hospital to MyOSCAR download is not possible now (it works in Boston so it can be done but our hospital will unlikely do this for now), we should work on the hospital to OSCAR download as an interim measure. I personally think this is a much harder step as the hsopital has to deal with different EMR's and the cost is ually much higher than the hospital to MyOSCAR route. Now patients will then have to get their hospital records by requesting them from their family physicians. I hope the distinction between the two methods is clear.
3. Now between providers - the concept of a proxy is that we lump groups of individual MyOSCAR users together to give it a name, e.g. the Crossroad clinic includes the physicians, nurses, MOA's etc but each individual MUST have a unique MyOSCAR account (see point 1). So if Dr. Cardiology Clinic (also a proxy group) sends a consult letter to the Crossroad clinic, what actually happens is that a MOA in the Cardiology clinic logs into MyOSCAR as a user and sends a message with the attached consult letter to the Crossroad clinic without specifying a specific receipient name. It is possible because the Crossroad clinic has given the Cardiology clinic sharing right and this MOA is a member of theCardiology proxy group (so the trust is "imputed" on her) - is that the right word?. So each clinic in Chilliwack must set up sharing rights to all the GP or specialist groups in the city in order for it to receive correspondences from them. And if the Cardiology clinic wants to receive referral requests from Crossroad, it must enable sharing for Crossroad too.
Notice all the transactions above remain inside a single MyOSCAR server and therefore maintain the high level of privacy and security that MyOSCAR is designed to do. Individual uploads and downloads are tracked and flow to persons and facilities where the information is intended.