Ontario Introduces new Legislation to Govern Electronic Health Records

Posted By Laura Crestohl – Oct. 28, 2013

This summer, the Ontario government introduced the Electronic Personal Health Information Protection Act (“EPHIPA”), which will amend the Personal Health Information Protection Act (“PHIPA”) to deal with the introduction of electronic health records (“EHRs”). The aim of the Bill is to regulate the privacy of individuals and their rights to their personal information in light of the specific concerns that surround EHRs. The bill went through its second reading and debate on October 10th, 2013.

The amendments govern the use, collection and disclosure of EHRs, and propose:

  1. the creation of “prescribed organizations” to create and maintain EHRs
  2. allowing patients to create consent directives
  3. giving patients the right to access their records
  4. allowing patients the right to request a correction of their records
  5. giving patients the right to know who accessed their records
  6. allowing patients to lodge complaints
  7. limiting the sharing of EHRs
  8. the creation of harsher sanctions for persons or organizations who breach the Act,
    and
  9. the creation of an independent advisory to advise the Ministry of Health and Long-Term Care (“the Ministry”) on policies regarding electronic health records.
Under PHIPA, only “health information custodians”, such as health care practitioners, long-term care homes, retirement homes, pharmacies and ambulance services, are allowed to collect individual’s health information. The new legislation will allow a new class of organizations, known as “prescribed organizations”, to collect and manage the information found in electronic health records. These organizations would have to be transparent about how they deal with and protect personal information.

EPHIPA would give individuals more control over the use, collection and disclosure of their personal health information. The bill would allow patients to create “consent directives” over who can, and who cannot, access or use their personal health information. These directives could be modified at any time, and can be overridden, if the patient gives consent, or in certain situations where a prescribed organization reasonably believes that collection would reduce or eliminate a risk of serious injury. Thus, in most circumstances, EPHIPA would have the effect of giving the patient more agency in controlling how their personal information is collected, used and disclosed by different health organizations.

The response to the proposed legislation has generally been positive. Ontario’s Information and Privacy Commissioner, Dr. Ann Cavoukian, commended the bill’s amendments to PHIPA. Commissioner Cavoukian stated:

These amendments are necessary to foster public trust and confidence, as the health sector transitions from paper-based records to electronic health records… I will continue to work closely with the Government and the health care sector to ensure a smooth and seamless transition into the digital era, while strongly protecting the privacy of Ontarians and the confidentiality of their personal health information.

As well, Megan Brister and Michelle Gordon of the International Association of Privacy Professionals claim that although EPHIPA formalizes many of the leading practices in the industry, organizations should consider the legislation while developing policies and practices related to EHRs, as to avoid costly rework if the legislation becomes law.

Universal Health Coverage

Posted By Anthony Maher – Oct. 16, 2013

With the eight Millennium Development Goals (MDGs) set to expire in 2015, health advocates are keen to ensure that the human right to health makes it onto the post-2015 global development agenda. First codified in the 1966 International Covenant on Economic, Social and Cultural Rights, the right to health provides for ‘the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’.

But what does this mean in concrete terms? How can this right be translated into concrete public policy?

A collective of actors from government, civil society, and finance has proposed adding the goal of Universal Health Coverage (UHC) as a way of achieving the right to health. On September 30, 2013, fifteen global organizations – including Oxfam and Save the Children, among others – published a joint letter urging United Nations member states to include UHC in the post-2015 development framework.

This letter draws attention to startling inequities in the global delivery of health services: a billion people worldwide are unable to obtain quality health care and 150 million every year are forced into poverty due to out-of-pocket health costs.

Universal Health Coverage is intended as a direct response to this reality. UHC is founded on the premise that all people ought to receive the health care they need, without suffering financial hardship in order to pay for it. As stated in the joint letter: ‘[UHC reforms] empower country leaders with greater ownership over their health sectors, while focusing attention on governments’ responsibility to fulfill progressively the right to health.’ Building on this, the Director-General of the World Health Organization Dr. Margaret Chan recently referred to UHC as ‘the single most powerful concept that public health has to offer’.

Nevertheless, the issue of how to implement Universal Health Coverage is the subject of much debate. Should there be a minimum threshold for public financing? What lessons can be learned from states – such as those in Latin America – that have enshrined UHC in their constitutions? How can UHC be pursued in tandem with the underlying determinants of health, such as good sanitation and gender equality?

These and other questions must be addressed if UHC is to gain widespread recognition as a realistic model for promoting health and reducing inequality in global society. As the Rockefeller Foundation recently observed, ‘here the debate is just starting.’

For more information on Universal Health Coverage, consult the report entitled ‘Universal Health Coverage: A Commitment to Close the Gap’.

Getting to Know the MJLH, vol 8: Rosel Kim, Executive Online Editor

Posted By Jennifer Anderson – Oct. 7, 2013
What do you do at the MJLH?
I am the Executive Online Editor – I manage the Online Editorial Board by coordinating the blog posts that appear on this website and updating the journal’s social media presence on Facebook, Twitter, and LinkedIn.
Qu’est-que vous avez fait cet été?
J’ai travaillé comme assistante de recherche au Centre de génomique et politiques, un centre multidisciplinaire à la Faculté de médecine à McGill. My research focused on genetic discrimination – where employers or health insurance companies might deny you insurance or employment based on your genetic predisposition, even if those predispositions may never manifest as real symptoms. As genetic testing becomes more mainstream (with private companies like 23andme offering direct-to-consumer testing that doesn’t require a doctor) and knowledge about our genetics more advanced, there is a need to think about how we store and share our genetic information.
At the end of the summer, I had the opportunity to travel to Israel, where I participated in a summer program on socioeconomic rights, offered jointly by the McGill and Hebrew University of Jerusalem law faculties.
Where do you get your health news?
CBC and BBC always have interesting health news. I also like to browse Timothy Caulfield’s tweets (@CaulfieldTim) for interesting headlines – he’s a professor of health law at University of Alberta.
In your opinion, which “big issues” in health law will future lawyers have to deal with?
Criminalization of HIV non-disclosure will continue to be an issue that is debated in the courts. In my opinion, there is more work to be done in educating people about the changing nature of HIV as a chronic condition (rather than the death sentence it was a decade or two ago) in developed countries.
I foresee that privacy issues surrounding e-health records will become a major issue as we move into paperless data storage. In September, the CBC reported that a Saskatchewan school received faxes containing medical information by mistake; if we’re having problems with faxes still, there is a good chance that we’ll be working out issues of e-health records for many years!
Avez-vous essayé un Montréal Food Truck cet été? Si oui, quel est votre truck favori?
Je n’ai pas essayé beaucoup de Food Trucks, mais j’ai essayé les saucisses de Nomade 06 et le sandwich de Grilled Cheese de Gargantua. I’m sad I never got to try food from the Au Pied de Cochon truck that everyone was raving about!