Information & Ethics Committee on Dec. 13th, 2006

[Dr. Bonnie Cham]

I would say that's a very difficult question to quantify. The way in which they may have been adversely affected is that information about their specific prescribing patterns are known to people who purchase that information.

If I can give a very simple example, a physician attended an education session about a particular drug—and this is a physician I know in Manitoba. Following that, her prescribing patterns were evaluated by the pharmaceutical industry representative in her area. She was phoned on about an every two-week basis to try to determine why the education she received wasn't being incorporated into a change in prescribing patterns. That was interrupting her work. It was close to harassment. It was obviously a direct marketing effort. We, as an association, would rather that information about individual physicians and their prescribing patterns wasn't in the hands of pharmaceutical representatives.

[The Chair, Liberal, Tom Wappel]

Yes, I understand that.

I think Ms. Nelson said something about mixing apples and oranges. There is a difference between whether or not it is personal information as defined by the act, and it may not be, and the use of that information and whether or not that use is proper. Those are two separate discussion topics.

My time is up, as was pointed out by the vice-chair.

We now go to Mr. Van Kesteren.

[Dave Van Kesteren, Conservative, Chatham-Kent—Essex, ON]

Thank you, Mr. Chair.

The trouble with having the last questions is all these people take all the good ones.

I want to just follow up on something, and this was asked on the other side too. The way I understand it, years ago doctors took their records and just put them in a filing cabinet. Is that really part of the problem? I can't see where there would be too much of a breach of privacy there. Someone's got to literally get into the filing cabinet.

Is it because we've moved, we've had this transition period into the computers? Is that part of the problem? Is that one of the reasons why we're seeing all this transition, and as well maybe a little bit of reluctance from physicians specifically?

[Dr. Bonnie Cham]

I believe it is the reason these safeguards need to be introduced. It's much easier to pull together databases that can be useful to other commercial interests or other very legitimate purposes. But we want to be able to protect that information if patients don't want to be part of these large databases.

I don't think we're seeing physician resistance really to those safeguards being put in place. We just want to make sure that they are not unduly burdensome and adding an extra administrative layer.

But I do think the move to electronic databases is a very big part of the need for these protections.

[Dave Van Kesteren, Conservative, Chatham-Kent—Essex, ON]

That leads to my second question.

Is there a danger, or is there a safeguard towards this danger—? When we go to databases, what takes precedence? Is it the patient's privacy or public health?

[Dr. Bonnie Cham]

That is a very individual, circumstantial kind of question that has to be addressed in any issue.

For example, even before electronic databases, if we look at the duty of confidentiality of physicians to their patients, if things are required because of risk to the patient or to identifiable persons, or if information is required to be transmitted because of law, then those duties override the confidentiality duty to the patient. It really depends very much on the nature of the information and what the intended purpose for it is. There would be ways through either research boards or regulatory boards to weigh those decisions, and that's why it's important to have frameworks set up to do that.

[Dave Van Kesteren, Conservative, Chatham-Kent—Essex, ON]

Of course, since we have a global network, is there a danger that perhaps insurance companies could access it, not necessarily from the Canadian site but by moving globally and then positioning themselves in other countries and gaining access to information on, you mentioned perhaps, HIV or something, or if somebody were taking drugs?

I'm picking on insurance companies, but is there that danger? Does that exist?

[Dr. Bonnie Cham]

We are concerned about the transborder data flow. Actually, that's one of the points we mentioned. I think that is a potential concern and why these databases have to be guarded safely. Research subjects in Canada who are participating in multinational trials could have their information located in the United States and could then be subject to acts such as the U.S. Patriot Act. These are issues that we feel Canadians need to be really proactive on to ensure that we're protecting our citizens' privacy.

[Dave Van Kesteren, Conservative, Chatham-Kent—Essex, ON]

Mr. Tilson was saying just a minute ago, too, that you people could have written a book on privacy. You don't need PIPEDA to tell you how to do it. I mean, you're much more stringent.

Am I getting this right? Other than the fact, such as the physician you were talking about who was being harassed, and that's a different issue—Is that really the thrust? Is that the thing we're most concerned about—in this series of questions I've asked—that we're moving to global information? Is that really what we're trying to protect more than anything else?

[Dr. Bonnie Cham]

I think that's probably the emerging issue that is the most important one. With PIPEDA, we've probably dealt a lot with the commercialization of information and those issues. It is those transborder flows, the availability of telehealth, and the fact that physicians may be providing services to people who don't live in their geographical area anymore. All these issues become very important when we consider how we're going to protect health information.

[Dave Van Kesteren, Conservative, Chatham-Kent—Essex, ON]

Good. Thank you.

[The Chair, Liberal, Tom Wappel]

Thank you.

M. Laforest, s'il vous plait.

[Jean-Yves Laforest, Bloc, Saint-Maurice—Champlain, QC]

Thank you.

Ms. Lavallée asked a question earlier with regard to the application of the federal Act in provinces where no equivalent provincial law is in effect.

Since you are representatives of a Canada-wide medical association, do you also represent physicians, pharmacists and dentists in areas where there are also provincial associations? Are there associations, such as the Quebec Medical Association, that represent them with regard to the protection of private information?

This question is addressed to all three groups.

[Jean Nelson]

I can answer on behalf of the CMA. We have a chapter called the Quebec Medical Association but our code of ethics applies throughout the country.

Our chapter is working on creating posters and a guide for physicians to help them improve their practice as required.

Indeed the principles involved in privacy protection are extensive; they do not come under any single authority. It’s like that everywhere.

[Jean-Yves Laforest, Bloc, Saint-Maurice—Champlain, QC]

Does that association report to the Canadian Medical Association or is it completely autonomous?

[Jean Nelson]

According to our bylaws, it is a part of the Canadian Medical Association. However, these people have their own sphere of influence in terms of negotiations at the provincial level. We also maintain contact with the Quebec Federation of General Practitioners.

[Jean-Yves Laforest, Bloc, Saint-Maurice—Champlain, QC]

What about dentists?

[Andrew Jones]

In dentistry we have the Canadian Dental Association that speaks for the over 18,000 dentists throughout the country. In the province of Quebec, there is a Quebec dental association that deals with Quebec-specific issues. It relates to the government in Quebec. And there's also the regulatory body, the order, in Quebec that regulates the dental profession within the province. But we at the Canadian Dental Association have individual voluntary members who join our association from the province of Quebec, and we speak for them on issues of national importance and here on issues with the federal government.

[Jean-Yves Laforest, Bloc, Saint-Maurice—Champlain, QC]

Are those people members of both associations?

[Andrew Jones]

Yes, there are dentists who belong to both—

[Jean-Yves Laforest, Bloc, Saint-Maurice—Champlain, QC]

Are they not all in the same situation?

[Andrew Jones]

—the Quebec dental association and the Canadian Dental Association. So yes, there are dentists who belong to both organizations in the province.

[Dr. Jeff Poston]

With pharmacy, the guidelines and codes of practice and posters and brochures that we produce may be used nationally. But all of the provinces have provincial licensing bodies. So the provincial l’Ordre des pharmaciens du Québec will be the regulatory body in Quebec that will often work with the other pharmacy association to deal with the specific issues as to how provincial legislation will affect pharmacy practice in those provinces.

So we provide some general information. We will provide individual brochures, leaflets, posters, that type of thing that may be used nationally. But the interpretation of legislation at the provincial level and its application to practice will be done by the provincial licensing body.

[Jean-Yves Laforest, Bloc, Saint-Maurice—Champlain, QC]

Thank you.

Ms. Lavallée, would you like to continue?

[Carole Lavallée, Bloc, Saint-Bruno—Saint-Hubert, QC]

Is there time left?