PHIPA (Personal Health Information Protection Act)
Privacy of personal information is an important principle to the Haliburton Highlands Family Health Team and the Haliburton Family Medical Centre. We are committed to collecting, using and disclosing personal information responsibly and only to the extent necessary for the services we provide. We try to be open and transparent about how we handle personal information. This document describes our privacy policies.
Who We Are
Our organizations, Haliburton Highlands Family Health Team and the Haliburton Family Medical Centre, includes at the time of writing 10 Physicians, 2 Nurse Practitioners, 1 Physician Assistant, 8 Nurses, Registered Dietitian, 2 Social Workers, Chiropodist, and 15 Administrative Staff. We use a number of consultants and agencies that may, in the course of their duties, have limited access to personal health information we hold. These include computer consultants, office security and maintenance, bookkeepers and accountants, lawyers, temporary workers to cover holidays, credit card companies, website managers and cleaners. We restrict their access to any personal information we hold as much as is reasonably possible. We also have their assurance that they follow appropriate privacy principles.
Consent, Capacity, and Substitute Decision-Making
The knowledge and consent of a patient are required for collection, use, or disclosure of that patient’s Personal Health Information (PHI), except where otherwise permitted or required by law. Consent includes Express Consent and Implied Consent. Express Consent is consent that has been clearly and unmistakably given by the patient to the Health Information Custodian (HIC), for the collection, use, or disclosure of PHI, either orally or in writing. Implied Consent is consent that a HIC concludes has been given by the patient, for the collection, use, or disclosure of PHI. Under PHIPA, a HIC is not required to obtain written or verbal consent every time PHI is collected, used, or disclosed, unless the HIC is disclosing PHI to a person or institution that is not a HIC.
Capacity and Substitute Decision-Making
Patients are presumed to be capable to make health information decisions, unless it is not reasonable to presume capacity. Think Capacity not age. There is no age of consent. To be considered capable a person must have the ability to:
- Understand the information that is relevant to the decision to collect, use, or disclose his/her PHI
- Appreciate the reasonable foreseeable consequences of his/her choices about the collection, use, or disclosure of his/her PHI
The health care provider who is proposing the treatment about which the information relates or the health care provider who holds the information decides capacity. If a patient is found to be incapable of making information decisions, only the person’s substitute decision maker (SDM) can make decisions on that person’s behalf (see section 26 of PHIPA for a ranked list of SDM’s).
|Person of any age||If capable||Can make decisions about release of everything in his/her own health record
|Person of any age||If incapable||Needs a substitute decision‐maker to release anything in health record
|Under age of 16 (birth to 16 less a day)||If capable||Can make decisions about release of everything in his/her own health record AND
A parent can also consent to release of information about any treatment or counselling that child did not consent to on his/her own BUT NOT IF THE CAPABLE CHILD OBJECTS TO PARENT MAKING SUCH DECISIONS
What is Personal Health Information (PHI)?
Personal health information (PHI) is information about an identifiable individual. Personal health information includes information that relates to:
- the physical or mental health of the individual (including family health history)
- the provision of health care to the individual (including identifying the individual’s health care provider)
- a plan of service under the Home Care and Community Services Act, 1994
- payments or eligibility for health care or coverage for health care
- the donation or testing of an individual’s body part or bodily substance
- the individual’s health number; or
- the identification of the individual’s substitute decision-maker
Why We Collect Personal Health Information
We collect, use and disclose personal information in order to serve our clients. For our clients, the primary purpose for collecting personal health information is to provide primary and secondary health care. For example, we collect information about a client’s health history, including their family history, physical condition and function and social situation in order to help us assess what their health needs are, to advise them of their options and then to provide the health care they choose to have. A second primary purpose is to obtain a baseline of health and social information so that in providing ongoing health services we can identify changes that are occurring over time.
We also collect, use and disclose personal health information for purposes related to or secondary to our primary purposes. The most common examples of our related and secondary purposes are as follows:
Related Purpose #1: To obtain payment for services or goods provided. Payment may be obtained from the individual, OHIP, WSIB, private insurers or others.
Related Purpose #2: To conduct quality improvement and risk management activities. We review client files to ensure that we provide high quality services, including assessing the performance of our staff. External consultants (e.g. auditors, lawyers, practice consultants, voluntary accreditation programs) may conduct audits and quality improvement reviews on our behalf.
Related Purpose #3: To promote our clinic, new services, special events and opportunities (e.g. a seminar or conference) that we have available. We will always obtain express consent from the client prior to collecting or handling personal health information for this purpose.
Related Purpose #4: To comply with external regulators. Our professionals are regulated by College of Physicians and Surgeons of Ontario, College of Nurses of Ontario, who may inspect our records and interview our staff as a part of its regulatory activities in the public interest. The [College] has its own strict confidentiality and privacy obligations. In addition, as professionals, we will report serious misconduct, incompetence or incapacity of other practitioners, whether they belong to other organizations or our own. Also, our organization believes that it should report information suggesting illegal behaviour to the authorities. In addition, we may be required by law to disclose personal health information to various government agencies (e.g. Ministry of Health, children’s aid societies, Canada Customs and Revenue Agency, Information and Privacy Commissioner, etc.).
Related Purpose #5: To educate our staff and students. We value the education and development of future and current professionals. We will review client records in order to educate our staff and students about the provision of health care.
Related Purpose #6: To fundraise for the operations of our organization, with the express or implied consent of our clients. If we rely on implied consent, we will only use the client’s name and address, we will provide clients with an easy opt-out option, and we will not reveal anything about our client’s health in the request.
Related Purpose #7: To facilitate the sale of our organization. If the organization or its assets were to be sold, the potential purchaser would want to conduct a “due diligence” review of the organization’s records to ensure that it is a viable business that has been honestly portrayed. The potential purchaser must first enter into an agreement with the organization to keep the information confidential and secure and not to retain any of the information longer than necessary to conduct the due diligence. Once a sale has been finalized, the organization may transfer records to the purchaser, but it will make reasonable efforts to provide notice to the individual before doing so.
Protecting Personal Information
We understand the importance of protecting personal information. For that reason, we have taken the following steps:
- Paper information is either under supervision or secured in a locked or restricted area.
- Electronic hardware is either under supervision or secured in a locked or restricted area at all times. In addition, strong passwords are used on all computers and mobile devices.
- Personal health information is only stored on mobile devices if necessary. All personal health information stored on mobile devices is protected by strong encryption.
- We try to avoid taking personal health information home to work on there. However, when we do so, we transport, use and store the personal health information securely.
- Paper information is transferred through sealed, addressed envelopes or boxes by reputable companies with strong privacy policies.
- Electronic information is either anonymized or encrypted before being transmitted.
- We do not post any personal information about our clients on social media sites and our staff members are trained on the appropriate use of social media sites.
- External consultants and agencies with access to personal information must enter into privacy agreements with us.
Retention and Destruction of Personal Information
We need to retain personal information for some time to ensure that we can answer any questions the patient might have about the services provided and for our own accountability to external regulatory bodies. However, in order to protect patient privacy, we do not want to keep personal information for too long.
We keep our client files for at least ten years from the date of the last client interaction or from the date the client turns 18.
We destroy paper files containing personal health information by cross-cut shredding. We destroy electronic information by deleting it in a manner that it cannot be restored. When hardware is discarded, we ensure that the hardware is physically destroyed or the data is erased or overwritten in a manner that the information cannot be recovered.
Patients Right to Access and Correction, Release of Patient Information and Lockbox
With only a few exceptions, the patient has the right to see what personal information we hold about them. We can help the patient identify what records we might have about them. We will also try to help the patient understand any information they do not understand (e.g., short forms, technical language, etc.). We will need to confirm their identity, if we do not know them, before providing them with this access. We reserve the right to charge $35.00 for the first twenty pages of records and 30 cents for each additional page.
We may ask the patient to put their request in writing. We will respond to their request as soon as possible and generally within 30 days, if at all possible. If we cannot give the patient access, we will tell them the reason, as best we can, as to why.
If the patient believes there is a mistake in the information, they have the right to ask for it to be corrected. This applies to factual information and not to any professional opinions we may have formed. We may ask the patient to provide documentation that our files are wrong. Where we agree that we made a mistake we will make the correction. At the patients request and where it is reasonably possible, we will notify anyone to whom we sent this information (but we may deny the request if it would not reasonably have an effect on the ongoing provision of health care). If we do not agree that we have made a mistake, we will still agree to include in our file a brief statement from the patient on the point.
The patient has the right to request that their PHI be locked or blocked from certain team members, or that we not disclose clinical information to external health care providers for health care purposes. It may be that the patient is requesting only one note, or a series of notes, from a particular team member be locked. It may be that the patient is requesting that a specific team member be locked from their entire record.
We must respond in a timely matter to these requests. Please forward such requests to the Privacy Officer.
If there is a Privacy Breach
While we will take precautions to avoid any breach of patient privacy, if there is a loss, theft or unauthorized access of PHI we will notify the patient.
Upon learning of a possible or known breach, we will take the following steps:
- We will contain the breach to the best of our ability, including by taking the following steps;
- Retrieving hard copies of personal health information that have been disclosed
- Ensuring no copies have been made
- Taking steps to prevent unauthorized access to electronic information (e.g., change passwords, restrict access, temporarily shut down system)
- We will notify affected individuals;
- We will provide our contact information in case the individual has further questions
- We will provide the Commissioner’s contact information
- We will investigate and remediate the problem, by;
- Conducting an internal investigation
- Determining what steps should be taken to prevent future breaches (e.g. changes to policies, additional safeguards)
- Ensuring staff is appropriately trained and conduct further training if required
Depending on the circumstances of the breach, we may notify and work with the Information and Privacy Commissioner of Ontario. In addition, we may report the breach to the relevant regulatory College if we believe that it was the result of professional misconduct, incompetence or incapacity.
If a Patient or Client Has Questions or Concerns?
Our Privacy Officer, Kim Robinson, can be reached at:
7217 Gelert Road, P.O. Box 870 Haliburton, ON K0M 1S0
Tel.: 705-457-1212 ext. 368
The privacy officer will attempt to answer any questions you may have.
If the patient wishes to make a formal complaint about our privacy practices, they may make it in writing to our privacy officer. She will acknowledge receipt of the complaint, and ensure that it is investigated promptly and that the patient is provided with a formal decision and reasons in writing.
The patient also has the right to complain to the Information and Privacy Commissioner of Ontario if they have concerns about our privacy practices or how their personal health information has been handled, by contacting:
Information and Privacy Commissioner/Ontario 2 Bloor Street East, Suite 1400 Toronto, Ontario M4W 1A8 Telephone: Toronto Area (416/local 905): (416) 326-3333 Long Distance: 1 (800) 387-0073 (within Ontario) TDD/TTY: (416) 325-7539
FAX: (416) 325-9195
This policy is made under the Personal Health Information Protection Act, 2004, S.O. 2004, c. 3. It is a complex statute and provides some additional exceptions to the privacy principles that are too detailed to set out here.