ppt 2007 afmc nola ries en (1)

8/2/2019 Ppt 2007 Afmc Nola Ries en (1)

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Contemporary Issues in Canadian Health Care

Nola M. Ries, MPA, LLMAdjunct Assistant Professor, University of Victoria

Research Associate, Health Law Institute, University of Alberta


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identify concerns about privacy,confidentiality and security of EHRs

discuss relevant professional and legal issues

highlight lessons learned from case studies


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The value of electronic health records astools to improve access, quality andcomprehensiveness of care should be

reinforced so that the public clearlyunderstands the benefits and demands oftheir introduction.

We recommend that providers,governments and the public jointly committo the rapid adoption of these tools.

(Health Council of Canada, Report to Canadians, 2005)


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issue of privacy, confidentiality and protection ofpersonal health information in the context of an EHRsystem is perhaps the most sensitive one raised

Currently, there is significant variation in privacylaws and data access policies across the country thatposes a challenge for EHR systems that aredependent on inter-sectoral and inter-jurisdictional

flows of personal health information.

Senator Kirby, Senate Report on the Health ofCanadians (2002)


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Privacy: ones right to control who has access toinformation about oneself

Confidentiality: a duty owed by one to preserve thesecrets of another

Security: mechanisms put in place to safeguard

privacy and ensure confidentiality is maintained


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Hippocratic oath

Whatsoever I shall see or hear concerning the life

of men, in

my attendance on the sick, or evenapart therefrom, which oughtnot to be noisedabroad, I will keep silence thereon, countingsuchthings to be as sacred secrets.


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right of privacy fundamental in a free anddemocratic society

includes patient's right to determine with whom heor she will share information and to know of andexercise control over use, disclosure and accessconcerning any information collected about him or

her right of privacy and consent are essential to trust

and integrity of the patient-physician relationship.


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public sector information and privacy laws health information laws

Manitoba (1997) Alberta (2001)

Saskatchewan (2003)

Ontario (2004) private sector privacy laws


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EHRs potentially conflict with privacy principlesunless patients control how the record is sharedand appropriate security measures are in place.

A coherent legal framework to appropriatelyprotect the privacy and confidentiality of personalhealth records is therefore an essential first stepfor successful EHRs

Amanda Cornwall, Connecting Health: A review of electronic healthrecord projects in Australia, Europe and Canada (2003)


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Should individual consent be requiredbefore information is included in EHR ordisclosed through EHR?

To be legally valid, consent generally mustbe informed:

Who will have access to info?

For what purposes? What security mechanisms are in place?

What are risks of unauthorized access?


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comprehensive health records

initially gave individuals right to refuseconsent

removed in 2003

retain right to restrict access tocomprehensive health record by givingwritten instruction


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Section 59: required individual consentbefore information could be disclosedelectronically

authorization for custodian to disclose purpose for disclosure identity of recipient acknowledgement of reasons, risk, benefits

date effective statement that consent may be revoked

Removed in 2003


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in facilitating a province wide electronic healthrecord, practical experience made it apparent thatgetting consent from Albertans was going to be

difficult and costly not possible to inform people in a meaningful way

of all the specific disclosures by electronic means,

which might ever be made of their healthinformationFrank Work, QC, Alberta Information & Privacy Commissioner


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patient consent required to includeinformation in EHR

pilot project in Tasmania (2004): many patients were not asked for consent

identified need for simple consent process

discussion about moving to presumedconsent / opt-out model


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National Health Service care record guaranteepublished May 2005

consent for sharing patient information in EHRis generally presumed

but You can choose not to have information inyour electronic care records shared

consistent with 2006 BMA statement


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maintain administrative, technical andphysical safeguards to protect confidentiality

and privacy measures to guard against risks associated

with EHRs audit logs privacy impact assessments


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benefits and risks of EHRs

professional obligations ethical and legal

patient rights

consent and control

achieving an appropriate balance

ppt 2007 afmc nola ries en (1)

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