Question: With Alberta Health announcing availability of another secure messaging service for patients and physicians, what does this mean for users of the Connect Care clinical information system?
Context: Alberta Health has contracted with Telus to make secure patient-physician messaging services more accessible during the COVID-19 pandemic; with BrightSquid the selected provider. An offering, branded as "MHR Secure Mail", is available at no cost to participating physicians until July 31, 2020. This will be promoted to Albertans. Patients may wonder whether or when they should use BrightSquid. Physicians may wonder when to use an existing AHS messaging system and when to use BrightSquid. The systems currently do not interoperate.
Answer: AHS strongly supports secure messaging solutions that meet regulatory requirements for messaging between patients and their physicians. This BrightSquid service promoted by Alberta Health until July 31, 2020, is one of many options. AHS supports physicians choosing a solution that best meets their practice requirements... and making sure that they have the required Privacy Impact Assessment addendum in place.
Physicians with independent clinics may elect to use the BrightSquid system alongside their existing electronic or paper records. Where AHS bears responsibility for the record of care (EMR or CIS), physicians should use AHS within-system secure patient communication tools or, failing that, AHS Secure Email.
Showing posts with label Privacy. Show all posts
Showing posts with label Privacy. Show all posts
Do Connect Care Users have an Information Manager Agreement?
Question: How should physicians respond when asked about an information manager agreement for use of a electronic record?
Answer: It's that time of year again. College of Physicians & Surgeons of Alberta (CPSA) practice permit renewals are due in just over a month. Many physicians will be completing their annual surveys. A survey section entitled "medical records" asks if the respondent shares patient information with other physicians and if an Information Sharing Agreement (ISA) is in place. Connect Care users may not know how to respond. We suggest:
Unfortunately, the CPSA standard respecting Information Sharing Agreements dates back to 2009 and has not been updated to reflect the advent of clinical information systems (CIS) capable of supporting the record of care across a continuum of care. The CPSA is aware and will be updating its annual survey for the next cycle.
Know that the CPSA participated in the development of the Clinical Information Sharing Approach (CISA) for Connect Care. This meets CPSA requirements and is an accepted surrogate for an ISA. CISA includes an Information Sharing Compact that all participating physicians must uphold.
Information Sharing Agreement: When asked if an ISA exists, say "Yes".
Custody of Patient Records: When asked if a written agreement exists to maintain custody and control of your patient records, you can answer "Yes" since this is provided for in Connect Care business continuity and most specialty group arrangements.
EMR Use: When asked if you currently use an Electronic Medical Record (EMR), select "Yes" and pick "Clinical Information Systems" as the type of EMR.
Level of EMR Use: When asked "What is the level of your EMR use?", you can select Level 5 as Connect Care is designed for shared care and has a full patient portal.
Control over EMR Use: When asked "How much control do you have over the EMR?", you can select the second option "Shared Custody and Control" since physicians actively customize Connect Care through Area Councils, Specialty Workgroups and User Groups. In addition, there are extensive personalization controls available to physician users.
Level of Netcare Use: When asked "What is the level of your Netcare use?", you can select Level 3 because Netcare PIN data can be imported and integrated into Connect Care and Connect Care shares summative information back to Netcare.
Answer: It's that time of year again. College of Physicians & Surgeons of Alberta (CPSA) practice permit renewals are due in just over a month. Many physicians will be completing their annual surveys. A survey section entitled "medical records" asks if the respondent shares patient information with other physicians and if an Information Sharing Agreement (ISA) is in place. Connect Care users may not know how to respond. We suggest:
Unfortunately, the CPSA standard respecting Information Sharing Agreements dates back to 2009 and has not been updated to reflect the advent of clinical information systems (CIS) capable of supporting the record of care across a continuum of care. The CPSA is aware and will be updating its annual survey for the next cycle.
Know that the CPSA participated in the development of the Clinical Information Sharing Approach (CISA) for Connect Care. This meets CPSA requirements and is an accepted surrogate for an ISA. CISA includes an Information Sharing Compact that all participating physicians must uphold.
Information Sharing Agreement: When asked if an ISA exists, say "Yes".
Custody of Patient Records: When asked if a written agreement exists to maintain custody and control of your patient records, you can answer "Yes" since this is provided for in Connect Care business continuity and most specialty group arrangements.
EMR Use: When asked if you currently use an Electronic Medical Record (EMR), select "Yes" and pick "Clinical Information Systems" as the type of EMR.
Level of EMR Use: When asked "What is the level of your EMR use?", you can select Level 5 as Connect Care is designed for shared care and has a full patient portal.
Control over EMR Use: When asked "How much control do you have over the EMR?", you can select the second option "Shared Custody and Control" since physicians actively customize Connect Care through Area Councils, Specialty Workgroups and User Groups. In addition, there are extensive personalization controls available to physician users.
Level of Netcare Use: When asked "What is the level of your Netcare use?", you can select Level 3 because Netcare PIN data can be imported and integrated into Connect Care and Connect Care shares summative information back to Netcare.
Is it okay for trainees to follow up on patient results after leaving a service?
Question: Residents and students can (and should) be copied on results associated with the orders they enter to the Connect Care clinical information system. Some orders do not get resulted until after the patient has left the hospital or the trainee has left the clinical service. Are we prohibited from accessing health information if not continuing as the patient's treatment physician?
Answer: Trainees may have concerns about a 2016 Alberta administrative law case (with clearer results on appeal); and the more recent Saskatchewan privacy commissioner reaction to ER physician access to charts of emergency patients that they had treated.
Health privacy legislation can differ in detail and interpretation from province to province. Alberta’s understanding of "circle of care" is not narrowly constrained by time or location alone. Need, role, purpose and accountability are important considerations.
For purposes of education (following up on a case), clinical feedback (seeing how one’s clinical decisions affected outcomes), quality control, practice audit and safety reviews, one remains in the circle of care "purpose". It can be important for authorized trainees to access, learn from, and possibly help improve results associated with the interventions they ordered in the care episode they participated in. Indeed, it could be argued that they should be particularly attentive to learning from their actions, as that was a key attribute of their role in the circle of care.
What is not okay is to access the record of a patient one has previously seen for a purpose unrelated to the specific care one participated in. For example, to explore other domains of care or types of information.
The Clinical Information Sharing Approach addresses questions like this.
Answer: Trainees may have concerns about a 2016 Alberta administrative law case (with clearer results on appeal); and the more recent Saskatchewan privacy commissioner reaction to ER physician access to charts of emergency patients that they had treated.
Health privacy legislation can differ in detail and interpretation from province to province. Alberta’s understanding of "circle of care" is not narrowly constrained by time or location alone. Need, role, purpose and accountability are important considerations.
For purposes of education (following up on a case), clinical feedback (seeing how one’s clinical decisions affected outcomes), quality control, practice audit and safety reviews, one remains in the circle of care "purpose". It can be important for authorized trainees to access, learn from, and possibly help improve results associated with the interventions they ordered in the care episode they participated in. Indeed, it could be argued that they should be particularly attentive to learning from their actions, as that was a key attribute of their role in the circle of care.
What is not okay is to access the record of a patient one has previously seen for a purpose unrelated to the specific care one participated in. For example, to explore other domains of care or types of information.
The Clinical Information Sharing Approach addresses questions like this.
How might one lose access to Connect Care?
Question: Under what circumstances might a Connect Care user lose access to the clinical information system?
Answer: There are access provisioning challenges that are being worked out pre-launch of the clinical information system (CIS). In the end, all those who need access to the CIS will have access to the CIS. There is a privacy awareness requirement and a training requirement, as explained in the Physician Manual.
Once access is established, it can be lost again if the user leaves the organization using Connect Care as the record of care or their role changes such that CIS access is no longer needed or appropriate. This is all normal security process.
There is another important way by which access might be lost... inactivity. In a sense, this happens when a user functionally removes themself from the Connect Care community. This too explained in the Physician Manual.
Answer: There are access provisioning challenges that are being worked out pre-launch of the clinical information system (CIS). In the end, all those who need access to the CIS will have access to the CIS. There is a privacy awareness requirement and a training requirement, as explained in the Physician Manual.
Once access is established, it can be lost again if the user leaves the organization using Connect Care as the record of care or their role changes such that CIS access is no longer needed or appropriate. This is all normal security process.
There is another important way by which access might be lost... inactivity. In a sense, this happens when a user functionally removes themself from the Connect Care community. This too explained in the Physician Manual.
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