AuthorHalyna N. Perun; Michael Orr; Fannie Dimitriadis
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
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.
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
2 S.O. 2004, c. 3, Sch. A [PHIPA].

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