I heard that there was going to be an amendment to FIPPA to
extend the protection of quality of care information created
outside of the QCIPA process. Is this going to happen?
An amendment to FIPPA has been proposed in the budget bill (Bill
173 – introduced on March 29, 2011) which will extend a
broader exemption to records created for quality purposes. Assuming
that this amendment is passed, there will be two types of
protection for quality of care records from access under FIPPA:
Exclusion for QCIPA Records
When the amendments to FIPPA were made to bring hospitals under
the legislation, the Quality of Care Information Protection
Act (QCIPA) was amended to provide that FIPPA does not apply
to "quality of care information" under QCIPA. This is an
exclusion from FIPPA, which means that an access
request under FIPPA cannot be made for any records of quality of
This was the only protection for quality assurance records in
FIPPA. Hospitals had significant concerns that other quality
assurance records created outside of the QCIPA process would be
exposed to access under FIPPA. Submissions were made to the
legislative committee that this would have an adverse effect on the
quality of care culture in hospitals. An amendment was suggested by
health care organizations including the OHA and HIROC but not
passed at that time.
Exemption for Non-QCIPA Quality Records
Now, in the budget bill (Bill 173), the government has
introduced a further amendment to FIPPA – to add an
exemption under section 18 to provide that the
head of an institution (hospital) may refuse to disclose a record
that contains "information provided to, or records prepared
by, a hospital committee for the purpose of assessing or evaluating
the quality of health care and directly related programs and
services provided by the hospital".
This proposed amendment is helpful in protecting quality related
records created outside of a QCIPA process. In order for
the exemption to apply, the information needs to be created by or
provided to a committee within the hospital related to quality of
care. The amendment also adds the word
"directly" in regards to "related programs and
services", which appears designed to confine the exemption to
direct health care activities as opposed to ancillary or
administrative issues which only indirectly impact on quality.
The exemption is discretionary ("the head may refuse to
disclose") and is subject to section 23 of FIPPA, under which
all exemptions may be overridden "where a compelling public
interest in the disclosure of the record clearly outweighs the
purpose of the exemption".
Therefore, the exclusion under QCIPA provides a
better or stronger protection from access under FIPPA than the
exemption for non-QCIPA quality records.
1. Review the Hospital 's quality of care review
Review the current practice of the hospital with respect to
QCIPA reviews – Should the QCIPA process be broadened to
include other issues if there is a concern that access to the
records will inhibit the review process?
Speak to department heads/managers to determine which other
bodies/groups within the hospital are undertaking quality reviews
and consider if any of these should be QCIPA protected.
Investigate how quality related activities are done and ask if
this is still appropriate and what alternate methods might be. For
example, are the activities done by individuals or on an ad hoc
basis without direction from a more formal committee process? If
so, an alternate method might be to bring it under a committee in
order for the exemption or exclusion to apply.
2. Review documentation practices for quality reviews.
Develop a standard system for documentation of quality related
Identify the records as created for quality purposes and for a
particular committee if applicable.
Develop standard documentation templates/formats for particular
types of reviews. Review the OHA CQIPA Toolkits (2004 and 2007) for
Review what is currently done, and what should be done, with
quality review working papers (eg. drafts, notes, extra copies of
Develop a record retention policy for documentation of completed
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