Introduction

• Author: Halyna N. Perun; Michael Orr; Fannie Dimitriadis
• Pages: 1-18

A. PRIVACY’S CONNECTION TO HEALTH CARE

The provision of health care is dependent on the availability of information.

Without complete and accurate information about a patient, health care

providers are challenged in determining appropriate treatment. Understand-

ing this need, patients share information about themselves with health care

providers and permit providers to acquire intimate details about themselves

through the provision of health care itself. Often, this information is of such a

private and sensitive nature that a patient may not even share it with family or

friends. Disclosures of such information to the wrong people can cause a

patient embarrassment, or even more tangible disadvantages.

Consequently, a patient generally does not make information available to

a health care provider without developing expectations about the use of the

information. A patient must trust a health care provider to use the information

in the best interests of the patient. If patients cannot trust health care

providers, and the organizations within which providers work, to keep their

information confidential and secure, then patients will be faced with the choice

between foregoing privacy and foregoing proper health care, neither of which

is an acceptable alternative.

An important goal of health information privacy legislation is to create a

framework in which this trust, so essential to the provision of health care, can

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1Introduction

be fostered in a consistent manner. This recognition of the relationship

between privacy and health care is not new. At least since the days of the Hip-

pocratic Oath,1people have recognized that health care, privacy, and confiden-

tiality are integrally linked.

While information must be kept private and secure, it must also be available

quickly for the purposes of health care. Enabling the effective and efficient shar-

ing of personal health information for the provision of health care while, at the

same time, ensuring that patients can trust that their information will be kept

private is key to creating a workable framework for health information privacy.

It must also be remembered that the delivery of health care does not occur

in a vacuum. Health care providers must be able to disclose information about

the provision of health care for supporting functions, such as to claim and

obtain payment for health care services, including payment by the Ontario

Health Insurance Plan. A provider must also be able to disclose information to

a professional governing body in the course of its investigation of professional

misconduct, or where the disclosure is required to protect public health.

Finally, any health information privacy regime, particularly one developed

in the context of a largely publicly funded health care system, needs to recog-

nize and accommodate uses of personal health information for purposes that

enable the effective planning and management of the health care system itself.

Health care delivery relies on health education, research, planning, and admin-

istration, and each of these, in turn, relies on some degree of access to person-

al health information.

The lengthy public dialogue that occurred in Ontario during the years that

led to the development of the Personal Health Information Protection Act, 20042

reflects the need to balance these various considerations and interests.

Guide to the Ontario Personal Health Information Protection Act

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1 This premise that patient information must be kept confidential is reflected in the

Hippocratic Oath, where the duty was first known to be articulated with respect to

physicians. It is widely accepted today that this duty of confidentiality applies to a

range of health care providers. See, for example, Re Axelrod (1994), 119 D.L.R. (4th) 37

(Ont. C.A.). The duty of confidentiality is part of a broader duty, often called a fiduci-

ary duty, to act in the best interests of the patient: McInerney v. MacDonald, [1992] 2

S.C.R. 138.

2 S.O. 2004, c. 3, Sch. A [PHIPA].