1. PRIVACY: 2014

2. Looking forward … to point of care access, integrated patient info from multiple providers 10 min. course covers: intro to connecting GTA (cGTA) privacy protection questions/help: Chief Privacy Officer (416-756-6448) or privacy@nygh.on.ca

3. Coming in 2014 connectingGTA (cGTA) - initiative of eHealth, LHINs, Canada Infoway integrates electronic clinical data from participating organizations, point of care access early adopter hospitals: NYGH, UHN, TEG, SM, SBHSC, MS, WOH, THP NYGH plans direct link: patient’s chart in Cerner e.g. John Smith (Cerner) to John Smith (cGTA)

4. Paper charts limited access, disclosure potential Electronic (Cerner) all NYGH patient data accessible upon login Health information networks, clinical data repositories; vast amounts of patient data accessible upon login Data integration: privacy risks magnified

5. Road to stronger point-of-care access participation requirement: compliance with cGTA privacy & security policies incl. training, end user agreements strong passwords privacy notice at login For more information: https://www.ehealthontario.ca/portal/server.pt/comm unity/frequently_asked_questions/2496https://www.ehealthontario.ca/portal/server.pt/comm unity/frequently_asked_questions/2496

6. The challenge of boredom Personal Health Information Protection Act: 8+ yrs familiarity can bring complacency privacy breaches rising: North America & beyond litigation, class actions a growing factor Canadian settlements low, cost of defending high refresher training helps avoid risk

7. Personal Health Information Protection Act (PHIPA) establishes rules governing collection, use, disclosure of personal health info (PHI) provides individuals rights of access, rights to control their own PHI patients increasingly exercising those rights

8. Personal health information means … identifying information in oral/recorded form physical/mental health, family health history provision of health care, identity of individual’s health care provider or substitute decision maker payments, eligibility for health care; donation of body part/substance; result: test/exam of body part/substance health card number; plan of service/Long-Term Care Act

9. Accountability for privacy we are all accountable credentialed staff, employees – contract & permanent, volunteers, students Vice Presidents: responsible for compliance within respective portfolios Chief Privacy Officer: facilitates compliance, official point of contact for all inquiries, complaints

10. Sharing with health care team only those who "need to know” have authority to access personal health information (PHI) i.e. primary care, attending & consulting physicians, residents, nurses, technicians, spiritual care & support staff directly involved in patient care patient and family centred, privacy protective care

11. Personal health information accuracy take all reasonable steps to ensure accurate, complete, up-to-date inform recipients of accuracy limitations patients have right to request correction, to attach a statement of disagreement to chart if requested change not made Note: correction requests re medical info are referred to physician/record creator

12. Consent to collect, use, disclose obtain consent first unless a law permits/requires activity without consent e.g. law requires we report communicable diseases, gunshot wounds law overrides any patient objection to disclosure

13. Must have capacity to consent must be voluntary, knowledgeable & relate to the information substitute decision maker (SDM) may consent on patient's behalf patient/SDM must understand they may withhold consent to collections, uses, disclosures 16 year-olds may consent or refuse on own behalf

14. Implied consent where elements of consent are established in the circumstances i.e. it is obvious that the patient knows the purpose for & consents to collection, use, disclosure; that they may give/ withhold consent request for treatment implies consent to necessary collection, use, disclosure

15. Express consent explicit agreement or permission to collect, use and disclose PHI can be given in person, by telephone or in writing document oral consent/refusal on patient chart

16. Limiting collection collection limited to that necessary to provide care, to carry out essential administration & reporting fair and lawful means to collect, no deception, coercion

17. Limiting use, disclosure PHI is used, disclosed to provide health care, as permitted/required by law permitted uses include: - service evaluation - educating students - quality improvement name & address used for fundraising 60 days after admission disclosure permitted for research approved by NYGH’s Research Ethics Board

18. Relying on implied consent implied consent permits sharing with health care team for care purposes unless patient/substitute decision maker objects permits disclosure to another health care provider for care unless consent expressly withdrawn/withheld

19. Express consent required before … disclosing to person who is not a health info custodian e.g. to insurer, lawyer, teacher, employer- refer to Release of Information Dept: 416-756-6209 media: no disclosure, refer to Corporate Communications 416- 756-6127; locating: 6002 consent required before disclosure to health info custodian when purpose is not health care

20. Photos/Audio/Video: express consent required no person may photograph or audio/videotape patients, staff physicians or volunteers without their express consent anyone who does should be asked to stop and delete the info; call Security if they refuse Security will request deletion & if refused, person may be escorted from hospital Google glass: photo, audio, video …

21. Permitted disclosure without consent patient is injured or incapacitated, unable to consent; disclose info necessary to permit contacting next of kin, friend, substitute decision maker may disclose to reduce, eliminate significant risk of harm to person or persons; disclose only necessary info to appropriate person or body – overrides patient objection to comply with subpoena/warrant or statute e.g. mandatory reporting of gunshot wounds, communicable diseases

22. Disclosure of admission, location, condition ask permission at first reasonable opportunity; record consent/objection on PowerChart no disclosure if patient or SDM objects or if VIP flag on chart describe condition in general terms: stable, fair, satisfactory, poor or critical unless patient expressly consents/requests greater disclosure ideally it is the patient who discloses as much/little as they want others to know

23. Patients’ right of access in-patient may view chart when it won't cause care disruption; ensure record security consult attending physician before giving patient access to mental health records to avoid causing harm (inpatient & after discharge) after discharge, patients complete release of information form, pay fee for copies for personal use please avoid creating expectation Health Records will immediately provide copies for personal use at no charge release of information request form, fee schedule on NYGH website at Your Health Information

24. Information and Privacy Commissioner/Ontario (IPC) provides oversight of compliance with the Personal Health Information Protection Act. The Commissioner: adjudicates access appeals, investigates privacy complaints and may issue public reports may enter and inspect premises, records, information management practices and require evidence under oath, affirmation has Order making power; may levy fines of up to $250,000.00 IPC Contact: 416-326-3333, www.ipc.on.cawww.ipc.on.ca

25. Thank-you For more information please contact Rita Reynolds Chief Privacy Officer at ext. 6448