Policy and Political Action

Policy & Political Action

Bill 119: Health Information Protection Act, 2015

The Registered Nurses’ Association of Ontario (RNAO) is the professional association representing registered nurses (RN), nurse practitioners (NP), and nursing students in Ontario. RNAO advocates for healthy public policy and we welcome this opportunity to provide input to the Standing Committee on Justice Policy regarding Bill 119, the Health Information Protection Act, 2015.


Schedule 1 proposes several amendments to the Personal Health Information Protection Act (PHIPA), 2004, and provides the legislative framework for the creation of an electronic health record (EHR) in Ontario. RNAO is supportive of many of the proposed amendments to PHIPA as it will move us one step closer to having a provincial EHR in Ontario. By providing real-time access to key health information at the point of care, health professionals will be able to provide more co-ordinated person-centred care with less duplication of services.

Summary of Recommendations: Schedule 1

  • Proceed with greater regulation around the viewing of PHI, as described in Section 1(2).
  • Section 55.3(11) stipulates that a prescribed organization must notify the HIC about a privacy breach to the EHR. RNAO urges for the inclusion of a requirement that the patient be notified in a timely manner, and specify by whom.
  • Proceed with Section 1(4)(3), which stipulates mandatory reporting to the IPC when a privacy breach occurs. We urge that the IPC be empowered to respond, in a meaningful way, to reported privacy breaches.
  • Remove the clause under Section 8(3) which requires HICs to notify regulatory colleges if an employee is terminated, suspended, or subject to disciplinary action related to personal health information, or if the employee resigns and there are grounds to believe that the resignation is related to an investigation or other action with respect to personal health information, given existing requirements under the Health Professions Procedural Code.
  • Specify an appropriate limitation period on prosecution of offenses under Section 23(8), of no more than five years after which the offence was alleged to have occurred.
  • Proceed with provisions in Section 55.3(3) regarding information that must be provided to the public. Add a clause that stipulates that the public be made aware of:
    a. How they may exercise their right under this legislation to provide consent directives to direct which elements of their PHI may be shared and with whom.
    b. Information about the circumstances under which these consent directives may be overridden (As laid out in Sections 55.7, 55.8).

  • Ensure that mechanisms are in place regarding PHI that is collected under a consent directive that is now part of the EHR, and to ensure that it is shared only with members of the health service team with whom the patient wishes it to be shared.
  • Work to remedy any concerns that the public may have about participation in the EHR, however, provide an option to opt out of the provincial EHR entirely for those who so choose.
  • Mandate the composition of the advisory committee (described in Section 55.11) to include at least one RN and one NP as well as a member of the public.
  • The Ministry of Health and Long-Term Care (MOHLTC) should initiate a discussion with stakeholders about ensuring that health professionals receive the education they need to understand the implications of this legislation.
  • Narrow clause (b) under Section 55.13 to appropriately specify what can be prescribed in regulation.

    RNAO applauds the MOHTLC's efforts to update current legislation/regulation through the Quality Care Information Protection Act (QCIPA) Review Committee, and through repealing and replacing the Quality Care Information Protection Act, 2004 with the updated QCIPA, 2015. RNAO is supportive of processes that give health facilities the opportunity to review critical incidents so they can improve quality of care. At the same time, the assurance of confidentiality is important for health professionals to be able to speak openly about critical incidents and to learn from errors. RNAO strongly believes that this need for confidentiality must be balanced with the need for transparency—for patients, their families and staff—all of whom deserve to know about the quality of care provided.

    Summary of Recommendations: Schedule 2

    • Clearly define the circumstances under which QCIPA may be applied to ensure that information is not unnecessarily shielded from patients, families or the public in the name of quality improvement.
    • Proceed with Section 2 (1), (2) and (3), which make explicit what is and is not considered QCI to help provide information to patients/families when critical incidents occur.
    • Strengthen Section 8(2) to allow the sharing of QCI with other quality of care committees, as well as with the public by establishing a database of QCI. RNAO urges the MOHLTC to work with stakeholders to support that sharing of QCI among health organizations for maximal benefit.
    • Proceed with Sections 10 and 11 to afford protection and assurance of non-retaliation for health professionals who disclose information to a QOC committee.
    • Identify further opportunities in legislation and regulation to assure confidentiality for health professionals when reviewing all critical incidents—both when QCIPA is applied and when it is not.
    • Consult with RNAO and other system stakeholders regarding the implementation of QCIPA, 2015, and provide training for all health professionals in the implementation of changes as a result of the bill.

    RNAO is pleased to provide input to the Standing Committee on Justice Policy regarding updates to the PHIPA, QCIPA and other corollary legislation under Bill 119. Thank you for giving us this opportunity to present our perspective. We believe that the practical and achievable recommendations described above will strengthen the bill and advance health service delivery that is of high quality, transparent and person-centred and respects appropriate privacy and confidentiality. We urge you to implement our recommendations and look forward to ongoing collaboration on these important matters.

    See the full submission with references below.

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