Protecting our patients personal health information (PHI) under the regulations of the Personal Health Information Protection Act (PHIPA) is a nursing responsibility. Nurses have both the ethical and legal responsibility to maintain our patient’s confidentiality and privacy as we are health information custodians (College of Nurses of Ontario, 2019; Information and Privacy Commissioner of Ontario, 2015).
The Office of the Information and Privacy Commissioner of Ontario (2015) outlined a document on circle of care and how health care custodians can share PHI for health-care related purposes. Although the “circle of care” cannot be clearly defined, there are six conditions when implied consent can be used to disclose PHI (Information and Privacy Commissioner of Ontario, 2015). It is important for the health care custodian to be aware that PHI can only be disclosed to certain other custodians for the “purpose of providing health care or assisting in the provision of health care to an individual” (Information and Privacy Commissioner of Ontario, 2015, p. 2). The Ontario Agency for Health Protection and Promotion is considered a health information custodian due to their role in the provision of health for research and support as legislated by the Government of Ontario (Public Health Ontario, 2019). This could include mandatory reporting for diseases such as HIV, Hepatitis A B C, and Influenza (Government of Canada, 2018). Another condition that must be met is that PHI must have been received from the individual of the PHI, his/her substitute decision maker (SDM), or from another health care custodian (Information and Privacy Commissioner of Ontario, 2015). Therefore, consent cannot be assumed if received from a third party such as an employer, insurer, or educational institution (Information and Privacy Commissioner of Ontario, 2015). The PHI that will be used, collected, or disclosed must be used for providing health care or assisting in the provision of health care to the person that the PHI relates (Information and Privacy Commissioner of Ontario, 2015). This is an important consideration when determining implied consent as there are a number of situations where this does not apply. These situations can include research, fundraising, marketing, or providing health care to another individual or a group of individuals (Information and Privacy Commissioner of Ontario, 2015). As well, implied consent cannot be provided to a person or organization that is not a health information custodian (Information and Privacy Commissioner of Ontario, 2015). Patient’s always have the right to withhold or withdraw consent of their PHI, however, in some cases, PHIPA requires that information is shared (Information and Privacy Commissioner of Ontario, 2015). An example of this would be the mandatory reporting to Public Health.
There is a difference between implied consent and expressed consent. Implied consent was discussed in the above paragraph, however, expressed consent is provided by the individual or SDM either verbally or written (Information and Privacy Commissioner of Ontario, 2015). In expressed consent, there are still required elements that must be fulfilled in order for the consent to be valid. These include:
- Consent obtained from the individual of the PHI or SDM
- Must be knowledgeable about the purpose, use, or disclosure and his/her rights to withdraw consent
- Must relate to the information being collected, used, or disclosed; and
- Cannot be obtained through deception or coercion (Information and Privacy Commissioner of Ontario, 2015)
Health Information on the Web
Personal health information and health information that is available on the internet continues to grow. Personal health information contains any identifying information about a person’s physical or mental health including family health history, care that has been provided, a plan for services, payment or eligibility for health care, donation of body parts or substances, health number, and the name of a client’s SDM (College of Nurses of Ontario, 2019). Health information can include information on a health related topic that can be found on the internet. For example, a fact sheet on how to manage hypertension could be considered health information and could alter health behaviours in people seeking out that information. In my role as a health care provider and a soon-to-be Registered Nurse (RN), it is important to hear the patients version of what they have learned from their own research in order to fully appreciate their level of understanding of the illness/symptoms/disease process. Depending on the accuracy of their information, the RN can provide evidence based information and recommendations based on their health issue. The RN can also promote the patients ability to participate in their own health care by recommending reputable websites such as The Heart and Stroke Society, if they want additional information on hypertension, for example.
Patients can post information about their own PHI, however, PHIPA does not allow for the disclosure of PHI of family members or SDM. So, if the person is sharing information about their own journey of hypertension and then states that their Father also has this condition, this would be a violation of PHIPA. As a soon-to-be RN, my role in this would be to educate people on PHIPA.
Health information is becoming more readily available for Canadians on the internet. There is a variety of sites available for people to access information on diseases or illnesses, basic self-care strategies, and several other health related topics. Depending on the person’s health literacy this can significantly impact the person’s ability to respond to the information provided on the internet or to critically examine information that is not reputable. Using the health discussion board on the web called: http://www.reddit.com/r/Diagnosed, I will examine a message thread that was posted and deconstruct the responses provided to the original poster.
I found an interesting thread that was posted almost 5 years ago from a nineteen year old female who had presented to the emergency room (E.R.) for tachycardia, hyperventilation, hypotension, and dizziness upon standing. This patient was monitored in the E.R. with lab work, ECG, and monitoring of her vital signs. She has had panic attacks in the past but had reported these episodes were different and not triggered by anxiety. She was discharged home with no explanation for her symptoms and directed to follow up with her primary health care provider. There was four responses to this woman about possible explanations for her symptoms and recommendations on further follow up. The first response was surprisingly accurate in describing the common diagnostic tests that are performed in the E.R. such as an ECG and lab work. However, this responder stated that having “black spots” or “dizziness” when standing or sitting up quickly is common. This is not common in everyone and should be investigated further as there could be a number of reasons for this phenomena. It is normal to have an increase of 5-20 bpm above resting, a slight increase to systolic pressure (up to 10 mm Hg), and a slight increase to diastolic (5 mm Hg) (Norris & Swiniarski, 2016). Another responder encouraged this woman to ensure that she was consuming enough fluids of 1-2 L per day and to relieve stress. This responder also directed the woman to check out a Wikipedia website on orthostatic hypotension. Although the recommendation for fluid intake and relieving stress was appropriate, it is worrisome to direct this woman to a Wikipedia site for health information. Another responder inquired about vertigo or hypothyroid. Hypothyroid manifests as fatigue, hair loss, brittle nails, dry skin, paresthesia in fingers, menstrual disturbances, subnormal body temperature and pulse rate, and an increase in weight (Williams & Day, 2016).
I enjoyed reading the posts on this website as it gave me a perspective I did not have before on health-related discussion boards. People can use these sites for support and expertise that may support their journey in determining causative factors for their symptoms, however, it is important that the people using these sites seek the opinion of a regulated health professional.
College of Nurses of Ontario. (2019, April). Confidentiality and Privacy – Personal Health Information. Retrieved from College of Nurses of Ontario: https://www.cno.org/globalassets/docs/prac/41069_privacy.pdf
Government of Canada. (2018, November 25). List of nationally notifiable diseases. Retrieved from Government of Canada: https://diseases.canada.ca/notifiable/diseases-list
Information and Privacy Commissioner of Ontario. (2015, August). Circle of Care Sharing Personal Health Information for Health-Care Purposes. Retrieved from Information and Privacy Commissioner of Ontario: https://www.ipc.on.ca/wp-content/uploads/Resources/circle-of-care.pdf
Norris, C. & Swiniarski, G. V. (2016). Assessment of cardiovascular function. In P. Paul, R.A. Day, & B. Williams (Eds.), Brunner & Suddarth’s Canadian textbook of medical-surgical nursing (3rd ed., pp. 716-753). Philadelphia, PA: Lippincott Williams & Wilkins.
Public Health Ontario. (2019, April 8). Privacy. Retrieved from Public Health Ontario: https://www.publichealthontario.ca/en/about/privacy
Unknown (Photographer). (Unknown). Privacy lock [digital image]. Retrieved from URL https://ryyacatjr.files.wordpress.com/2015/11/privacy_lock_300_jpg.jpg
Williams, B. & Day, R. A. (2016). Assessment and management of patients with endocrine disorders. In P. Paul, R.A. Day, & B. Williams (Eds.), Brunner & Suddarth’s Canadian textbook of medical-surgical nursing (3rd ed., pp. 1334-1379). Philadelphia, PA: Lippincott Williams & Wilkins.