Upload
ayen-chavez
View
227
Download
0
Embed Size (px)
Citation preview
8/2/2019 Ppt 2007 Afmc Nola Ries en (1)
1/17
Contemporary Issues in Canadian Health Care
Nola M. Ries, MPA, LLMAdjunct Assistant Professor, University of Victoria
Research Associate, Health Law Institute, University of Alberta
8/2/2019 Ppt 2007 Afmc Nola Ries en (1)
2/17
identify concerns about privacy,confidentiality and security of EHRs
discuss relevant professional and legal issues
highlight lessons learned from case studies
8/2/2019 Ppt 2007 Afmc Nola Ries en (1)
3/17
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)
8/2/2019 Ppt 2007 Afmc Nola Ries en (1)
4/17
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)
8/2/2019 Ppt 2007 Afmc Nola Ries en (1)
5/17
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
8/2/2019 Ppt 2007 Afmc Nola Ries en (1)
6/17
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.
8/2/2019 Ppt 2007 Afmc Nola Ries en (1)
7/17
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.
8/2/2019 Ppt 2007 Afmc Nola Ries en (1)
8/17
public sector information and privacy laws health information laws
Manitoba (1997) Alberta (2001)
Saskatchewan (2003)
Ontario (2004) private sector privacy laws
8/2/2019 Ppt 2007 Afmc Nola Ries en (1)
9/17
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)
8/2/2019 Ppt 2007 Afmc Nola Ries en (1)
10/17
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?
8/2/2019 Ppt 2007 Afmc Nola Ries en (1)
11/17
comprehensive health records
initially gave individuals right to refuseconsent
removed in 2003
retain right to restrict access tocomprehensive health record by givingwritten instruction
8/2/2019 Ppt 2007 Afmc Nola Ries en (1)
12/17
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
8/2/2019 Ppt 2007 Afmc Nola Ries en (1)
13/17
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
8/2/2019 Ppt 2007 Afmc Nola Ries en (1)
14/17
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
8/2/2019 Ppt 2007 Afmc Nola Ries en (1)
15/17
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
8/2/2019 Ppt 2007 Afmc Nola Ries en (1)
16/17
maintain administrative, technical andphysical safeguards to protect confidentiality
and privacy measures to guard against risks associated
with EHRs audit logs privacy impact assessments
8/2/2019 Ppt 2007 Afmc Nola Ries en (1)
17/17
benefits and risks of EHRs
professional obligations ethical and legal
patient rights
consent and control
achieving an appropriate balance