Access to Your Personal Ontario Health Information
Author: Barbara Legate, Partner
In the bad old days, access to your personal health information was paternalistically guarded. The level of specificity you obtained from a physician, hospital, Long Term Care facility and the like, was a function of what they were prepared to share. It was thought that patients were not sophisticated enough to appreciate the information and would misinterpret it; would second-guess the health care provider; didn’t need it because the health care provider would let them know what was needed; errors might be found out; or it was just a bother.
In the modern era, it is recognized that your health information is yours. In Ontario, pieces of legislation institutionalize your right to access to your health information.
It is important information for you to have about yourself in many situations. For example, my doctor may be alright with my cholesterol level, but I may notice it creeping up over time, and want to do something proactive about it.
Access to Your Personal Claims History
Residents of Ontario have health care paid for by the Ontario Health Insurance Plan (OHIP). Physicians, hospitals, labs, clinics and Long Term Care facilities make claims under the Plan just like you might make a claim for a benefit under an insurance policy. The health care provider has a number, and you have an OHIP number. Who has claimed what for your care is kept in a data base maintained by the Ministry of Health and Long Term Care (MHLTC). It is called your Personal Claims History (PCH).
Under section 45 of the Personal Health Information Protection Act, 2004 (PHIPA), an individual has the right to access their personal health information such as the PCH.
There are two kinds of records available from the MHLTC. The first is the PCH, which includes information about the date of service, who provided it, and where it was provided. A request must be made in writing either on line or mailed to the MHLTC. All requests will be processed within 30 calendar days of being received by the ministry.
The second is called a Decoded OHIP Summary which provides the same information as the basic PCH, but also includes the billing codes used, a description of what the code means, a diagnostic code, the diagnostic code description, the specialty code of the provider, who referred you to the provider, and how much was paid.
For example, if your family doctor sees you for a bought of depression, then refers to a psychiatrist, the result would look something like this:
|Date||FSC||FSC description||DiagCd||Diag code description||Clinic No||PCN clinic code||Provider||Speccd||Refer Phys No||#serv||Feepd||HospNo||expl|
|2015-01-10||A007A||Intermed assess/well baby care-FP GP PAED||311||Depressive or other non-psychotic disorders, not elsewhere||0000||FMAW||123456||00||1||44|
It is important to remember that this information is a billing record, nothing more. Actual diagnosis, test results and medical records are maintained by the provider, and/or the institution or facility they practice in or with.
You can find a physician’s contact information on The College of Physicians and Surgeons of Ontario website.
Access to your personal medical and hospital records
As you would expect, you and the maker of the health record are entitled to see the record. Otherwise, and with a few exceptions, you must consent to the disclosure of your health records.
The Personal Health Information Privacy Act, 2000 law provides your right to access under s. 45:
The Right of access
- (1) Subject to this Part, an individual is entitled, in accordance with this Part, to obtain access to records of personal health information relating to the individual that is in the custody or under the control of a health information custodian.
Informal access (2) Nothing in this Part prevents a health information custodian from granting an individual access to a record of personal health information, to which the individual is entitled to access, if the individual makes an oral request for access or does not make any request for access.
Communications (3) Nothing in this Part prevents a health information custodian and an individual from communicating with each other with respect to personal health information relating to the individual that is in the custody or under the control of the custodian.
Access by person making decision 46. (1) A person who is authorized under this or any other Act to consent or to make a decision on behalf of or in the place of an individual, or to participate in planning for an individual’s care, is entitled to access to a record of personal health information relating to the individual in accordance with this Part if the record is needed to make the decision or to participate effectively in planning for the individual’s care.
Access by parent etc. (2) A parent of a child who is less than 16 years of age or a children’s aid society or other person who is lawfully entitled to give or refuse consent to a treatment in the place of the parent is entitled, under subsection (1), to access to a record of personal health information relating to the child unless the record relates to,
(a) treatment within the meaning of the Health Care Consent Act, 1996, about which the child has made a decision on his or her own in accordance with that Act; or
(b) counselling in which the child has participated on his or her own under the Child and Family Services Act.
Some of the exceptions are:
- Disclosure to a custodian of a record who is a health care practitioner or a facility or organization that provides health care for the purpose of providing or assisting in providing health care to the individual.
- Disclosure for the purpose of determining or verifying eligibility of an individual to receive health care or other health-related benefits.
- Disclosure to eliminate or reduce a significant risk to an individual’s safety. (Clause 33 (a))
- Disclosure under certain circumstances in a legal proceeding. However, health care practitioners and facilities or organizations that provide health care are not permitted to disclose personal health information about their patients or clients in proceedings unless the individual consents, the court or other body holding the proceeding determines that the disclosure is essential in the interests of justice or certain other circumstances apply.
The Personal Health Information Privacy Act, 2000 sets out the process for obtaining access to your record pursuant to a written request by the individual or, in certain circumstances, a substitute decision-maker.
What is in the record?
Most hospitals maintain electronic records. Those records can be accessed by persons who work within the hospital, and physicians. To the extent that the hospital has an electronic record, it will be able to produce an audit trail identifying who opened the electronic record and when. Some may have more information than that, depending on their software. You are entitled to know who looked at that record. Requesting the audit trail is one way to get some information about who consulted your chart and when.
Hand written notes and electronic notes made by anyone treating you, consulting about you, or attending on you, and labs, imaging records (X-ray, CT, MRI, ECG, Electronic Fetal Monitor Strips etc), ambulance reports, transfer records, and orders are some of the records you might see.
What you are not entitled to see
You are NOT entitled to health information gathered about you for purposes such as quality assurance reviews, peer reviews or ethics reviews. For example, if the Hospital you were treated at was concerned about the quality of care you received, and conducted a quality assurance review, that review is not available to you. The idea is that disclosure may result in people involved being less than forthcoming, which thwarts the goal of improving care.
Quality of care information does not include originals or copies of records about health care or related services provided in the hospital or by the facility, organization or person that were not prepared exclusively for a committee review.
In certain circumstances, a health information custodian may refuse to give an individual access to a record of his or her personal health information, for example, if the access could reasonably be expected to result in harm to the treatment or recovery of the individual, injury to the mental condition of another individual or bodily harm to another individual or if the access could reasonably be expected to constitute an unjustified invasion of another individual’s personal privacy.
If a health information custodian refuses an access request in whole or in part, you are entitled to make a complaint to the Information and Privacy Commissioner.
If you believe there has been an error or omission in your record of personal health information you may request in writing that the health information custodian amend the record. The custodian is required either to amend the record as requested by the individual or to attach a statement of disagreement to the record stating that the custodian has not made the amendment requested.
The Act sets out a list of persons who are authorized to consent or refuse consent on behalf of an individual to a collection, use or disclosure of personal health information relating to the individual. The individual may be living or deceased and may be capable or incapable with respect to personal health information. The list of substitute decision-makers for an incapable individual is ranked according to priority.
A person who is determined to be incapable with respect to personal health information may apply to the Consent and Capacity Board for a review of the determination. The Board may also appoint a representative to make decisions about personal health information on behalf of an incapable person. The application can be made either by the incapable person or the person wishing to become the representative.