Personal Health Information Protection Act Regulations
The Ministry of Health released a series of three regulations under the Personal Health Information Protection Act (PHIPA) for public consultation. The OMA engaged in discussions with Ministry staff to learn more information, and submitted a response to each proposed regulatory amendment by the respective closing dates in July 2020. Below is a brief overview of each proposed regulation and the OMA response.
The first regulation proposed to allow ICES and Ontario Health to disclose data to the government to support the Health Data Platform for COVID-19 pandemic planning. The regulation as proposed did not stipulate any limitations on the possible uses of data or timelines for how long the government can continue to receive and keep the data. The OMA responded to the proposal highlighting the need for parameters and timelines on the use of data to be set.
Read the PHIPA submission.
The second regulation proposed amendments to proclaim Part V.1 of PHIPA relating to the electronic health record (EHR). Of note, the proposed regulation set out requirements for patient consent directives, as well as notice for consent overrides by providers. The OMA responded to the proposal with a number of technical and policy recommendations, including the importance of privacy not acting as a barrier to the provision of care, the need for clarity for the profession on consent directives and patient education, and the importance of protecting the safety of providers who override consent directives.
Read the PHIPA amendment submission.
The final regulation was on the interoperability of digital health assets, and was accompanied by a proposed Digital Health Information Exchange (DHIEX) policy. While interoperability is an important way to enhance integrated care and ensure that physicians can share patient information, the regulation and policy as proposed placed additional obligations on community-based physicians (who are health information custodians), including requiring physicians to make sure the system (e.g., EMR) they use is compatible with specifications yet to be developed by Ontario Health. The OMA launched a consultation process with all Sections, requesting feedback on the regulation and policy from Section Executives, which informed our final submission. Members who were interested in learning more and/or participating in the consultation process were also encouraged to connect directly with their Section Executive.
Our submission reflected the concerns raised through the Section consultation feedback, and we submitted that the proposed approach of using PHIPA to achieve interoperability is problematic as it targets the end user (physicians) instead of developers (vendors); downloads significant obligations, burden and costs onto physicians; and results in a lack of physician choice and risk of physician disenfranchisement.
We responded with the position that the government has two choices to achieve interoperability in the system:
- Instead of the punitive approach of using PHIPA as a lever that places undue burden on physicians, the obligations to achieve interoperability should be placed on vendors, or
- If the proposal to achieve interoperability via regulating physicians through PHIPA is pursued, the OMA submits:
- The costs associated with fulfilling regulatory requirements for EMRs are arbitrable, and
- To ease implementation, the existing OntarioMD vendor management and certification program should be relied upon to fulfil physician accountability and reporting requirements.
Read the digital health interoperability submission.
In all OMA submissions, we reiterated the fundamental importance of data governance in the system, and the need for the government to collaborate with the profession, and the OMA’s willingness to co-lead this work with the Ministry of Health.
Ontario College of Pharmacists Consultation on Prescribing for Minor Ailments
The Ministry of Health asked the Ontario College of Pharmacists (OCP) to develop regulatory amendments to enable an expanded scope of practice for pharmacists to prescribe for 12 minor ailments, including: urinary tract infections, dermatitis, insect bites, conjunctivitis, allergic rhinitis, oral thrush, cold sores, hemorrhoids, gastroesophageal reflux disease (GERD), dysmenorrhea (menstrual cramps), musculosketelal sprains and strains, and impetigo. The intent is to improve access to care in the community and to reduce the need for emergency or urgent care visits.
The OCP consulted with relevant stakeholders on this issue and the OMA provided feedback. Read the minor ailments submission.
The response noted:
- While treatment for some minor ailments may be relatively straightforward, others may mask other more serious underlying health conditions, for example, GERD may be myocardial infarction. Prescribing for a misdiagnosed condition could result in great harm to patients and delays in receiving potentially life-saving treatment.
- Physicians spend years learning the clinical skills to make a differential diagnosis. It’s not clear how the OCP would provide a comparable education.
- For minor ailments where risk of harm is lower – for example, cold sores or allergic rhinitis – pharmacist prescribing may be appropriate as an interim measure. Pharmacists must notify the patient’s primary care provider regarding the condition and the drug prescribed.
- If approved, pharmacists must prescribe from a specific list of drugs rather than categories of drugs that contain a broad range of substances.
- Pharmacists must adhere to relevant conflict of interest rules to ensure prescriptions are appropriate and necessary.
Bill 175
On February 25, 2020, the Ontario government tabled Bill 175, Connecting People to Home and Community Care Act, 2020. The legislation, which passed in July, amended portions of the Connecting Care Act, 2019 (CCA), the Ministry of Health and Long-Term Care Act (MHLTCA), and the repeal of the Home Care and Community Services Act, 1994 (HCCSA).
The OMA submitted comments on the Bill and its regulatory proposals in April 2020 to the Ministry of Health. This submission included support for the elements of Dan’s Law, which will enable coverage for end-of-life health care in Ontario for residents of other provinces. The submission was updated in June to reflect challenges associated with the COVID-19 pandemic.
On June 16, OMA President Dr. Samantha Hill, OMA Chief Executive Officer Allan O’Dette, and OMA Chief of Economics, Policy & Research Dr. James Wright, made a deputation to the Standing Committee on the Legislative Assembly on Bill 175, Connecting People to Home and Community Care Act, 2020.
The OMA stressed that this as an opportunity to address long-outstanding issues and inefficiencies, and examine critical areas that affect the delivery of home and community care. These include:
- Enhancing physician ability to access home and community care for their patients, and increasing the rapid delivery of services;
- Improving communication between primary care and other physicians and community care, with access to care co-ordinators after hours, and easy exchange of information electronically among providers;
- More services to be available from a social determinants of health perspective;
- Strengthening the role of care co-ordinators to focus on patient navigation as well as co-ordination, as ultimately, more seamless and integrated care will impact the success of Ontario Health Teams (OHTs) and be a key line of defence against hallway medicine;
- Minimizing paperwork and red tape in determining levels of community care; and
- Recognizing primary care as a critical hub for care co-ordination.
Finally, the OMA stressed that the government will need to properly fund home and community care to ensure equitable access to services, and in all parts of the province.
For a copy of the OMA’s Bill 175 submission please email health.policy@oma.org.