Privacy and Access to Patient Records

Yes. The College’s authority to do this comes from Sections 36 and 40 of the Regulated Health Professions Act, 1991 (the RHPA) and sections 83 and 83.1 of the Health Professions Procedural Code (the HPPC). Physiotherapists are legally required to cooperate with the College’s quality assurance program requirements, including access to patient records.

The RHPA and HPPC make it clear that the College’s right to access overrides all other confidentiality provisions. This duty to cooperate includes facilities and records maintained under any other legislation or authority, including public hospitals, Home and Community Care Support Services, long-term care facilities and the private sector.

However, we have noted that the wording in the HPPC is not specific enough to provide unequivocal advice on whether the College can require a health information custodian, who is not a physiotherapist, to provide a copy of the record.

No. Section 43. (1) of the Personal Health Information Protection Act permits health information custodians (HICs) to disclose personal health information to a regulatory College under the Regulated Health Professions Act (RHPA) for the purpose of administration and enforcement of the RHPA.

When assessment documents are ready to be shared with an assessor, a TitanFile channel is created by the Quality Assurance Team. Each physiotherapist’s assessment has their own channel created on TItanFile. Several TitanFile features ensure that assessment documents remain secure, private, and confidential.

These features include:

Read Only: The assessor added to the channel to access a PT’s patient records cannot post messages or add files to the channel.

Password Security: The Quality Assurance Team’s account password is changed every three months.

Channel expiration: The Assessor’s access to the channel is set to expire exactly one week after the scheduled assessment to coincide with the due date of the assessor’s final report.

Custom data retention: 30 days after a document channel has been deleted, it is permanently deleted from all TitanFile backup servers.

Two-factor authentication: The assessor upon creating a TitanFile account, will need to set-up two-factor authentication (2FA). Two-factor authentication is requested whenever the assessor accesses the assessment channel.

Limited viewer: The assessor is made a “limited viewer.” This means the assessor cannot download them on to their personal computer/device. Additionally, the assessor cannot print the files.

Audit logs: Notifications are sent to the Quality Assurance Team email inbox when a PT submits their patient files, as well as when the assessor accesses the documents in the assessment channel. All conversation and channel histories are downloaded once the physiotherapist’s assessment case file is closed.

Co-operation with Committee and Assessors

82. (1) Every member shall co-operate with the Quality Assurance Committee and with any assessor it appoints and in particular every member shall, a. permit the assessor to enter and inspect the premises where the member practises;

b. permit the assessor to inspect the member’s records of the care of patients;

c. give the Committee or the assessor the information in respect of the care of patients or in respect of the member’s records of the care of patients the Committee or assessor requests in the form the Committee or assessor specifies;

d. confer with the Committee or the assessor if requested to do so by either of them; and

e. participate in a program designed to evaluate the knowledge, skill and judgment of the member, if requested to do so by the Committee.

Inspection of premises

(2) Every person who controls premises where a member practises, other than a private dwelling, shall allow an assessor to enter and inspect the premises.

Inspection of records

(3) Every person who controls records relating to a member’s care of patients shall allow an assessor to inspect the records…

Conflict

(5) This section applies despite any provision in any Act relating to the confidentiality of health records. 1991, c. 18, Sched. 2, s. 82.

5. (3) The assessment may include, a. inspecting and reviewing the member’s premises, records and portfolio;

b. interviewing the member and his or her staff;

c. requiring the member to answer, orally or in writing, questions that relate to the member’s type of practice; and

d. requiring the member to examine simulations that relate to the member’s type of practice. O. Reg. 532/98, s. 5 (3).

(4) The Committee shall appoint an assessor to carry out the practice assessment but the assessor may obtain any assistance he or she considers appropriate in carrying out the assessment. O. Reg. 532/98, s. 5 (4).

(5) The assessor shall prepare a report on the assessment and submit it to the Committee, with a copy to the member. O. Reg. 532/98, s. 5 (5).

Other Rights and Acts

9. (2) Nothing in this Act shall be construed to interfere with,...

e. the regulatory activities of a College under the Regulated Heath Professions Act, 1991, the College under the Social Work and Social Service Work Act, 1998 or the Board under the Drugless Practitioners Act;

Disclosures Related to this or Other Acts

43. (1) A health information custodian may disclose personal health information about an individual,...

b. to a College within the meaning of the Regulated Health Professions Act, 1991 for the purpose of the administration or enforcement of the Drug and Pharmacies Regulation Act, the Regulated Health Professions Act, 1991 or an Act named in Schedule 1 to that Act

36. (1) Every person employed, retained or appointed for the purpose of the administration of this Act, a health professional Act or the Drug and Pharmacies Regulation Act and every member of a Council or committee of a College shall preserve secrecy with respect to all information that comes to his or her knowledge in the course of his or her duties and shall not communicate any information to any other person except, a. to the extent that the information is available to the public under this Act, a health professional Act or the Drug and Pharmacies Regulation Act

b. in connection with the administration of this Act, a health professional Act or the Drug and Pharmacies Regulation Act, including, without limiting the generality of this, in connection with anything relating to the registration of members, complaints about members, allegations of members’ incapacity, incompetence or acts of professional misconduct or the governing of the profession;

c. body that governs a health profession in a jurisdiction other than Ontario;

d. as may be required for the administration of the Drug Interchangeability and Dispensing Fee Act, the Health Insurance Act, the Independent Health Facilities Act, the Ontario Drug Benefit Act, the Narcotic Control Act (Canada) and the Food and Drugs Act (Canada);

e. to the counsel of the person who is required to preserve secrecy; or

6. with the written consent of the person to whom the information relates. 1991,c. 18, s. 36(1); 1996, c.1, sched. G, s. 27(1).

(1.1) clauses (1) (c) and (d) do not apply with respect to reports required under section 85.1 or 85.2 of the Code. 1993, c. 37, s. 1.

(2) No person or member described in subsection (1) shall be compelled to give testimony in a civil proceeding with regard to matters that come to his or her knowledge in the course of his or her duties. 1991, c. 18, s. 36 (2).

40. (4) Every person who contravenes subsection 36 (1) is guilty of an offence and on conviction is liable to a fine of not more than $25,000. 1993, c. 37, s. 2.

January 2009