I appreciate the opportunity to respond to the letter submitted by Dr Figurski.

I believe that the lack of a control group for patient satisfaction, lack of randomization, and differences between the study and control group were adequately addressed under “Study limitations” published in the paper.

In three cases, I scheduled additional appointments as clinically required. I did not consider these appointments, two electronic and one in person, as “unscheduled care.” For the study purposes, I only considered visits to the emergency department or walk-in initiated by the patient without my knowledge as “unscheduled.”

Responding to a patient using the Medeo platform on my iPhone took approximately 2 minutes per instance, including billing the MSP fee code 10006 (Specialist Email Patient Management/Follow-Up) using a separate Accuro iPhone app.

This research was conducted without any funding from any source. Transparency and academic integrity is very important to me in terms of conflict of interest. I felt so strongly on this point that, on my own accord, I sold all of my shares in QHR before this paper was accepted for publication by the BCMJ. The BCMJ has a conflict-of-interest declaration process for peer-reviewed papers. It is noteworthy that subsequent to acceptance of the paper, QHR was acquired by Loblaw on 22 August 2016 with a significant increase in the QHR share price. I can confidently declare that I currently have no financial interest in QHR or its subsidiaries. I am, however, an unapologetically enthusiastic user of QHR’s products, Accuro and Medeo, and a proponent for the use of novel technology to improve patient care. As I concluded in the paper, I hope my research can be used to help develop a more rigorous, multicentre, randomized controlled study by institutions that have the resources to conduct this kind of research. The Vernon Jubilee Hospital does not fall into this category.
—Hamish Hwang, MD, FRCSC, FACS