Evidence of meeting #25 for Access to Information, Privacy and Ethics in the 39th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was care.
A recording is available from Parliament.
4:40 p.m.
Bloc
Carole Lavallée Bloc Saint-Bruno—Saint-Hubert, QC
Ms. Cham, you gave an interesting example of what you consider inappropriate use of medical information. Mr. Wappel replied that it was more a question of revealing information on a physician’s practice than one of revealing personal information.
Can you give us an example of inappropriate use of medical information?
4:40 p.m.
Chair, Committee on Ethics, Canadian Medical Association
I'm just giving that a moment of thought.
4:40 p.m.
Chair, Committee on Ethics, Canadian Medical Association
I actually don't have any specific examples.
I don't know if you're aware of any that have been reported to the association, Jean.
December 13th, 2006 / 4:40 p.m.
Assistant Director, Legal Services and Chief Privacy Officer, Canadian Medical Association
Ms. Lavallée, so I can understand correctly, are you talking about information on the health of patients or information—
4:40 p.m.
Bloc
Carole Lavallée Bloc Saint-Bruno—Saint-Hubert, QC
We are talking here about the protection of private information. We asked Ms. Cham earlier to give us an example. It seems that the information revealed was not private information but rather information on physicians’ practices. We know that pharmaceutical companies have access to this information through their sales data in any given sector, especially when the physician practices in a small community.
Do you have examples to give us? Our time is running out, I’m sorry. You could answer us in writing if the answer is not readily available. I would like to know if you have examples of cases where revealing a patient’s private information constitutes a violation of the law.
4:40 p.m.
Executive Director, Canadian Pharmacists Association
I know of just one example, and it goes back to Mr. Van Kesteren's question. I think one of the things that's important to recognize is that most of the data or information that gets collected is de-identified from a patient's perspective. So a lot of these databases that get created for research purposes or for public health purposes don't actually have the direct identification of the patient in them. I think that's becoming a really important principle with respect to the handling of health care information, that when it gets aggregated and into databases, one of the really important processes is that it is de-identified so you're unable to identify individual patients from the data.
So there is a very important level of protection of the patient at that level of data aggregation
4:45 p.m.
Assistant Director, Legal Services and Chief Privacy Officer, Canadian Medical Association
I can tell you about a case where both the Federal Commission and the Alberta Commission were involved. A fax transmission was misdirected. The case was reported by the Federal Commission and we can therefore give you the file number. The work was shared because one legal aspect concerned Alberta while another was under federal jurisdiction. We will send you the information on the subject.
4:45 p.m.
Liberal
4:45 p.m.
Conservative
David Tilson Conservative Dufferin—Caledon, ON
Dr. Halstrom, I don't know what the percentage is, but many people have insurance. You have the dental work done, you give them your insurance information, and the insurance company knows what dental work has been performed before you even leave the office. They know all about what you just did.
I am assured that all of you protect the information you have, but then the insurance company has information on the work you've just done. I don't know whether there are restrictions on the insurance company or whether you're concerned about that.
4:45 p.m.
President, Canadian Dental Association
We would be concerned about any use of that, but they can only have information on the procedure that was done on a given tooth or in a given quadrant. It's specific to the work that was done, not to the overall health record.
4:45 p.m.
Conservative
David Tilson Conservative Dufferin—Caledon, ON
There is the question of personal information, the definition of personal information, and the exclusion of certain information. Provincial and federal governments are concerned about the issue of wait times. I'm sure the medical people are concerned, and maybe the dental people too; we all are. If certain information is excluded, does that essentially euchre the government people from trying to cut down on wait times?
4:45 p.m.
Chair, Committee on Ethics, Canadian Medical Association
That type of information can be collected in a way that keeps the names of patients confidential but is able to track how long wait times are. There are certainly programs in many of the provinces that are tracking wait times, keeping all of that information confidential from anybody other than the people giving the direct care. But you're able to know exactly when a patient accessed a system and how long it took them to get to surgery, without releasing their name or any personal information. So I don't think that protecting privacy would impede that kind of data collection.
4:45 p.m.
Conservative
David Tilson Conservative Dufferin—Caledon, ON
There are people who say that the definition of personal information is too broad. Do you agree with that?
4:45 p.m.
Chair, Committee on Ethics, Canadian Medical Association
I probably don't agree with that. I think we have to be broad in our definition and protect all personal information about patients and people.
4:45 p.m.
Conservative
David Tilson Conservative Dufferin—Caledon, ON
I'm returning to the issue of wait times. There's a problem. We're trying to figure out...I mean, this applies to the druggists. You mentioned statistics on health care and research. If you get too tight on this information it can't be released.
4:45 p.m.
Executive Director, Canadian Pharmacists Association
It's a bit of a two-edged sword. It's important that patient information is protected, but you certainly want to make sure you have quite a rich database of information to enable you to manage the system effectively.
Some really careful thought has to be given to some of these definitional issues. If we're concerned about the efficiency and effectiveness of the health care system in general, a lot of this information relating to utilization—whether it's utilization of operating theatres, drugs, or whatever—has to be collected, disclosed, and analysed in a way that helps us make improvements to the system.
The critical piece is that the information needs to be collected, but there need to be some peer reviews so it isn't interpreted and used without some serious consideration of other factors that might be influencing utilization. The peer review piece is important in how it gets used.
4:50 p.m.
Conservative
David Tilson Conservative Dufferin—Caledon, ON
You can release information as to what doctors are prescribing, and you can release the names of the doctors. Should you be allowed to release the names of the doctors? I'm going to ask both of you to answer that question.
4:50 p.m.
Executive Director, Canadian Pharmacists Association
I think what happens, throughout the history of the pharmacy, is that the data gets collected, in fact, by a whole variety of people, particularly third-party payers, and the data gets released to market research companies. The requirement is that all of this information not include a patient's name, that it's de-identified from the patient's perspective.
I think what we were saying—
4:50 p.m.
Conservative
4:50 p.m.
Executive Director, Canadian Pharmacists Association
The physician's name is included. What we're saying is that the information.... Let me give you an example. Taking the example that my colleague from the CMA qualified, we wouldn't see that information being allowed for the direct targeting of individual physicians for marketing purposes. We would not support that.
However, for example, information could be used--perhaps on an aggregate basis or even, you could argue, on an individual physician basis—if you had a physician, for example, who was prescribing wildly out of line with established guidelines. I think the important issue we have to wrestle with is whether that particular physician's prescribing behaviour should be investigated in some way by their provincial licensing body, or whatever, or by some peer review body.
I think there is a distinction between the evaluation and use of information to improve the effectiveness of the system and the use of information for direct targeted marketing purposes. In both cases, you may need the identity of the physician, but it does come down to this question of how things are being used and for what purposes they're being used.
4:50 p.m.
Conservative
4:50 p.m.
Chair, Committee on Ethics, Canadian Medical Association
Maybe I can just comment that I would agree with those comments entirely, that we're not trying to protect physicians' prescribing patterns from being analyzed in order to cause improvements to the system. We're very open to peer review or having regulatory authorities look at making sure that physicians are practising at a good level of care. What we would like to see restricted is the selling of those prescription patterns for commercial interests. We feel it's important for them to be available for furthering and improving the system. For secondary commercial interests is where we would see this. We would worry that patients—
