Canada: Getting Connected: Digital Health And Information Sharing Under Bill 74

Health Law Bulletin
Last Updated: May 15 2019
Article by Daniel Fabiano, Sophie MacRae and Jordana Keslassy

This bulletin, the seventh in our series on Bill 74: The People's Health Care Act, 2019, provides an overview of technology, information sharing and privacy aspects of Ontario's new health care legislation and describes the province's vision for an integrated and connected health care system.

Applications are now being accepted from health service providers who would like to be designated as an Ontario Health Team. The first call for self-assessments closes on May 15, 2019. Certain groups will be selected to submit a full application based on the self-assessments. As reported in our bulletins published on April 18 and April 25, providers that would like to become an Ontario Health Team must successfully complete an application and in-person visit, and begin implementation of the Ontario Health Team model (at which time they will be referred to as an "Ontario Health Team Candidate"), before they will be designated as an Ontario Health Team (a stage referred to as "maturity"). Digital health capabilities are expected in applicants, Ontario Health Team Candidates and Ontario Health Teams.

The Ontario Ministry of Health and Long-Term Care (the "Ministry") has released a guidance document for applicants, Ontario Health Teams: Guidance for Health Care Providers and Organizations (the "Guidance Document"). Among the Ministry's expectations are compliance with a number of digital and privacy-related standards. The proposed "digital first approach" will require Ontario Health Teams to provide digital choices for patients to access care and health information, and use digital tools to communicate and share information among providers. Applicants will be expected to expand their digital tools during implementation. The Ministry has committed to minimizing barriers for the first Ontario Health Team Candidates.

This bulletin describes the role of technology and information sharing in the Ontario Health Team model, sets out the expectations at each phase of becoming an Ontario Health Team and describes the tools, services and steps that the Ministry has proposed to advance the model. It also includes privacy considerations that each member of a proposed Ontario Health Team must consider when implementing the model.

Technology is Central to the Ontario Health Team Model

One of the main goals of the Ontario Health Team model is to integrate and coordinate providers and services. The vision is that patients will move seamlessly between different providers and settings in their Ontario Health Team. Another goal of the Ontario Health Team model is to meet needs across rural, urban and northern communities. It is likely that access to technology will be even more important in areas where travel time to see a care provider in person is longer.

The Guidance Document describes the rationale for the new model, including that, currently, patients experience fragmented care, long wait times, and are required to provide the same information to each provider they see. Lack of communication or miscommunication is considered to be one of the most common patient complaints about the current system. The Ontario Health Team model, as envisioned, will be interconnected so that patients do not have to repeat their health history or take a test multiple times for different providers.

Readiness and Implementation

Self-Assessment and Application

The Guidance Document indicates that groups who have already partnered and can collectively demonstrate key capabilities will be identified for early implementation. The Guidance Document sets out readiness criteria for applicants (for both the self-assessment and formal application stage) which include:

  • demonstrating that most partners in the proposed Ontario Health Team have the ability to digitally record and share information with one another (e.g. point-of-service systems are in place and provincial clinical viewers are used by most providers);
  • demonstrating that at least some partners have the ability to adopt and provide digital options for decision support, operational insights, population health management and tracking/reporting key indicators;
  • identifying a senior-level, single point of contact for digital health activities;
  • identifying existing digital health gaps and confirming a commitment to develop a plan (with provincial support, if desired) to address them; and
  • confirming a plan to share information across partners for the purposes of integrated care delivery, planning and quality improvement.

The Guidance Document also explains that the readiness criteria include a commitment to offer one or more virtual care services to patients such as email, secure messaging, phone and video visits and digital self-care supports. Applicants will also be expected to propose a plan to provide patients with some digital access to their health information. Providers who are invited to complete a full application will be provided with details on provincial policies and standards that an applicant's plans will be expected to meet.

Year One of Implementation

After the first year of implementation, Ontario Health Team Candidates are expected to meet the following criteria:

  • have a harmonized information management plan in place;
  • increase adoption of relevant digital health tools; and
  • have plans in place to streamline and integrate point of service systems and use data to support patient care and population health management.

Implementation is expected to be consistent with provincial frameworks that will be shared prior to the beginning of the implementation process. The first year targets also include that 10-15% of patients who receive care will digitally access their health information.

Designated Ontario Health Teams

At maturity, Ontario Health Teams will use digital health solutions to support effective health care delivery, ongoing quality and performance improvements, and better patient experience.

The Guidance Document sets out expectations for what the digital health goals will look like when fully implemented. Ontario Health Teams at maturity will be expected to have the following capabilities:

  • to adopt provincial tools and services and adhere to provincial standards;
  • to efficiently and effectively communicate, and digitally and securely share information, among all providers in a system or network;
  • to drive performance improvements through clinical and data standardization, advanced analytics and strong information management practices to enable population health management, quality improvement and outcomes measurement; and
  • to provide patients with digital choices such as virtual care and full and timely digital access to patient health records that empower patients to manage their health.

The Ontario Health Team model is also intended to address bureaucratic and administrative hurdles that prevent providers from delivering coordinated care to their patients. A secure means to share necessary information among Ontario Health Team members is a priority.

Getting Connected

Ontario Health Team Candidates and teams who are identified as "In Development" (meaning not yet in a position to become an Ontario Health Team Candidate) will receive priority access to provincial digital health services and tools, and change management support. Examples of these services and tools listed in the Guidance Document include provincial clinical viewers, ONE ID and provincial client and provider registries (each currently hosted by eHealth Ontario) and eConsult (currently hosted by the Ontario Telemedicine Network).

Policies and standards will be provided to Ontario Health Team Candidates and those "In Development" to guide their redesign of their digital health and information management practices, if required.

Privacy Considerations

In order to deploy new electronic medical record and virtual care solutions as part of an Ontario Health Team, providers must consider a range of privacy issues arising out of the Personal Health Information Protection Act, 2004 ("PHIPA") as well health professional record-keeping requirements.

In particular, privacy law requirements (such as limitations on collection of, access to and disclosure of personal health information, security requirements, and breach notification) will apply to each member of the Ontario Health Team. This will require team members to develop policies and procedures to ensure both individual and collective compliance. In particular, for Ontario Health Teams that consist of multiple providers (i.e., separate health information custodians acting as a team), steps must be taken to ensure that the personal health information of patients is only disclosed among team members to the extent that they are involved in the patient's "circle of care" – i.e., the implied consent regime under PHIPA which permits certain health information custodians to assume an individual's implied consent to collect, use or disclose personal health information for the purpose of providing health care. This may require technological measures to segregate patient information in a shared electronic medical record system, and/or seeking the consent of patients to the retention of their information in such a system. It will also require such a system to be capable of responding to consent directives under PHIPA's lockbox regime, in which a patient can notify a health information custodian about access, use or disclosure limitations on his or her personal health information (which can include barring other providers from accessing or using that information).

The Guidance Document notes that proposed teams that consist of multiple providers may seek to be designated as a single health information custodian under PHIPA. This may mitigate some of the potential privacy law risks arising out of a shared electronic medical record platform. However, it does not obviate the need for common, integrated privacy and security policies and practices across all team members.

To the extent that existing legislation impedes providers from participating in the Ontario Health Team Model, the Guidance Document indicates that the Ministry will identify and consider the need for any reforms. Given this, and the above PHIPA considerations, we may see changes to Ontario's health privacy regime in the near future.

Finally, of note, the Guidance Document notes that research shows that successful models for integrated care contain an "integrated digital health ecosystem to manage patient health information and financial data". There is no further discussion of what financial data will be shared among members of Ontario Health Teams, but applicants will likely need to consider privacy laws more broadly if they are to become fully integrated.

Looking Ahead

Integration is the focus of the new Ontario Health Team model and has been addressed from various perspectives in our series of bulletins on Bill 74, from governance to employment to funding. The backbone of integration will be the ability to share information. Privacy law will apply, and should be a key focus, in all stages of implementation.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

To print this article, all you need is to be registered on Mondaq.com.

Click to Login as an existing user or Register so you can print this article.

Authors
Similar Articles
Relevancy Powered by MondaqAI
 
In association with
Related Topics
 
Similar Articles
Relevancy Powered by MondaqAI
Related Articles
 
Up-coming Events Search
Tools
Print
Font Size:
Translation
Channels
Mondaq on Twitter
 
Mondaq Free Registration
Gain access to Mondaq global archive of over 375,000 articles covering 200 countries with a personalised News Alert and automatic login on this device.
Mondaq News Alert (some suggested topics and region)
Select Topics
Registration (please scroll down to set your data preferences)

Mondaq Ltd requires you to register and provide information that personally identifies you, including your content preferences, for three primary purposes (full details of Mondaq’s use of your personal data can be found in our Privacy and Cookies Notice):

  • To allow you to personalize the Mondaq websites you are visiting to show content ("Content") relevant to your interests.
  • To enable features such as password reminder, news alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our content providers ("Contributors") who contribute Content for free for your use.

Mondaq hopes that our registered users will support us in maintaining our free to view business model by consenting to our use of your personal data as described below.

Mondaq has a "free to view" business model. Our services are paid for by Contributors in exchange for Mondaq providing them with access to information about who accesses their content. Once personal data is transferred to our Contributors they become a data controller of this personal data. They use it to measure the response that their articles are receiving, as a form of market research. They may also use it to provide Mondaq users with information about their products and services.

Details of each Contributor to which your personal data will be transferred is clearly stated within the Content that you access. For full details of how this Contributor will use your personal data, you should review the Contributor’s own Privacy Notice.

Please indicate your preference below:

Yes, I am happy to support Mondaq in maintaining its free to view business model by agreeing to allow Mondaq to share my personal data with Contributors whose Content I access
No, I do not want Mondaq to share my personal data with Contributors

Also please let us know whether you are happy to receive communications promoting products and services offered by Mondaq:

Yes, I am happy to received promotional communications from Mondaq
No, please do not send me promotional communications from Mondaq
Terms & Conditions

Mondaq.com (the Website) is owned and managed by Mondaq Ltd (Mondaq). Mondaq grants you a non-exclusive, revocable licence to access the Website and associated services, such as the Mondaq News Alerts (Services), subject to and in consideration of your compliance with the following terms and conditions of use (Terms). Your use of the Website and/or Services constitutes your agreement to the Terms. Mondaq may terminate your use of the Website and Services if you are in breach of these Terms or if Mondaq decides to terminate the licence granted hereunder for any reason whatsoever.

Use of www.mondaq.com

To Use Mondaq.com you must be: eighteen (18) years old or over; legally capable of entering into binding contracts; and not in any way prohibited by the applicable law to enter into these Terms in the jurisdiction which you are currently located.

You may use the Website as an unregistered user, however, you are required to register as a user if you wish to read the full text of the Content or to receive the Services.

You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these Terms or with the prior written consent of Mondaq. You may not use electronic or other means to extract details or information from the Content. Nor shall you extract information about users or Contributors in order to offer them any services or products.

In your use of the Website and/or Services you shall: comply with all applicable laws, regulations, directives and legislations which apply to your Use of the Website and/or Services in whatever country you are physically located including without limitation any and all consumer law, export control laws and regulations; provide to us true, correct and accurate information and promptly inform us in the event that any information that you have provided to us changes or becomes inaccurate; notify Mondaq immediately of any circumstances where you have reason to believe that any Intellectual Property Rights or any other rights of any third party may have been infringed; co-operate with reasonable security or other checks or requests for information made by Mondaq from time to time; and at all times be fully liable for the breach of any of these Terms by a third party using your login details to access the Website and/or Services

however, you shall not: do anything likely to impair, interfere with or damage or cause harm or distress to any persons, or the network; do anything that will infringe any Intellectual Property Rights or other rights of Mondaq or any third party; or use the Website, Services and/or Content otherwise than in accordance with these Terms; use any trade marks or service marks of Mondaq or the Contributors, or do anything which may be seen to take unfair advantage of the reputation and goodwill of Mondaq or the Contributors, or the Website, Services and/or Content.

Mondaq reserves the right, in its sole discretion, to take any action that it deems necessary and appropriate in the event it considers that there is a breach or threatened breach of the Terms.

Mondaq’s Rights and Obligations

Unless otherwise expressly set out to the contrary, nothing in these Terms shall serve to transfer from Mondaq to you, any Intellectual Property Rights owned by and/or licensed to Mondaq and all rights, title and interest in and to such Intellectual Property Rights will remain exclusively with Mondaq and/or its licensors.

Mondaq shall use its reasonable endeavours to make the Website and Services available to you at all times, but we cannot guarantee an uninterrupted and fault free service.

Mondaq reserves the right to make changes to the services and/or the Website or part thereof, from time to time, and we may add, remove, modify and/or vary any elements of features and functionalities of the Website or the services.

Mondaq also reserves the right from time to time to monitor your Use of the Website and/or services.

Disclaimer

The Content is general information only. It is not intended to constitute legal advice or seek to be the complete and comprehensive statement of the law, nor is it intended to address your specific requirements or provide advice on which reliance should be placed. Mondaq and/or its Contributors and other suppliers make no representations about the suitability of the information contained in the Content for any purpose. All Content provided "as is" without warranty of any kind. Mondaq and/or its Contributors and other suppliers hereby exclude and disclaim all representations, warranties or guarantees with regard to the Content, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. To the maximum extent permitted by law, Mondaq expressly excludes all representations, warranties, obligations, and liabilities arising out of or in connection with all Content. In no event shall Mondaq and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use of the Content or performance of Mondaq’s Services.

General

Mondaq may alter or amend these Terms by amending them on the Website. By continuing to Use the Services and/or the Website after such amendment, you will be deemed to have accepted any amendment to these Terms.

These Terms shall be governed by and construed in accordance with the laws of England and Wales and you irrevocably submit to the exclusive jurisdiction of the courts of England and Wales to settle any dispute which may arise out of or in connection with these Terms. If you live outside the United Kingdom, English law shall apply only to the extent that English law shall not deprive you of any legal protection accorded in accordance with the law of the place where you are habitually resident ("Local Law"). In the event English law deprives you of any legal protection which is accorded to you under Local Law, then these terms shall be governed by Local Law and any dispute or claim arising out of or in connection with these Terms shall be subject to the non-exclusive jurisdiction of the courts where you are habitually resident.

You may print and keep a copy of these Terms, which form the entire agreement between you and Mondaq and supersede any other communications or advertising in respect of the Service and/or the Website.

No delay in exercising or non-exercise by you and/or Mondaq of any of its rights under or in connection with these Terms shall operate as a waiver or release of each of your or Mondaq’s right. Rather, any such waiver or release must be specifically granted in writing signed by the party granting it.

If any part of these Terms is held unenforceable, that part shall be enforced to the maximum extent permissible so as to give effect to the intent of the parties, and the Terms shall continue in full force and effect.

Mondaq shall not incur any liability to you on account of any loss or damage resulting from any delay or failure to perform all or any part of these Terms if such delay or failure is caused, in whole or in part, by events, occurrences, or causes beyond the control of Mondaq. Such events, occurrences or causes will include, without limitation, acts of God, strikes, lockouts, server and network failure, riots, acts of war, earthquakes, fire and explosions.

By clicking Register you state you have read and agree to our Terms and Conditions