Medical record fee flap reaches privacy commissioner

The Ontario Hospital Association said the provincial government’s proposal to amend regulations that govern how much the public pays for access to their medical records is unnecessary and could potentially result in increased cost to the patient.

The OHA issued its response earlier this week at the end of a 60-day period that followed the publication of a proposed regulation by the Ministry of Health and Long-Term Care to amend Regulation 329/04 under the Personal Health Information Protection Act (PHIPA).

If passed, the proposed regulation, which was published in the Ontario Gazette on March 11, 2006, would allow health-care institutions to charge a maximum of $30 for services. These include receipt and clarification of a request for a record, providing a fee estimate, locating and retrieving the record and photocopying or printing a record up to a maximum of 20 pages. The proposed regulation would also charge additional fees for services such as photocopying a record that exceeds 20 pages, for example. The current legislation allows health care providers to set the amount, which can vary widely from one to another.

John Letherby a spokesperson for the ministry, reading a prepared statement, said, “the government is currently reviewing the submissions it has received, including any submissions from hospitals and will report in the fullness of time.”

The government did not provide any further details on when the regulation might be passed or how much additional charges would cost. The Alberta government has approved a regulation similar to the one the Ontario government is proposing under its Health Information Act. A similar piece of legislation called the Freedom of Information and Privacy Act at provincial and municipal levels governs the public sector in Ontario.

The current PHIPA legislation says that the health information worker can’t charge a fee that either exceeds a prescribed amount or an amount of reasonable cost recovery, said Manuela De Re, health law legal council for the Ontario Information and Privacy Commissioner‘s (IPC) office.

“When you talk about reasonable cost recovery, everyone’s perception is slightly different,” said De Re.

Since the PHIPA legislation was introduced in November 2004, the IPC has received 12 formal complaints from citizens about fees, added De Re. That prompted Ontario’s Privacy Commissioner, Ann Cavoukian to write several letters to the ministry, asking them to address the fees issue through regulation.

In its submission to the ministry, the OHA said it supports the government’s effort to ensure that patients’ pocketbooks aren’t gouged when obtaining personal medical information. But it expressed concern that, “the proposed fee structure will impose additional administrative burdens on a process that is already extremely time sensitive, which could ultimately result in increased costs to the patient for access to their health record.”

A patient who accesses her chart and reviews it for two hours would be charged $170 under the current structure and $314 under the proposed fee structure, according to a scenario in the OHA’s report.

Similarly, Gabriella Rattner, manager of health records at Mount Sinai Hospital in downtown Toronto, said most requests for patient access to records from sources like a family physician are free-of-charge. But under the proposed regulation, that could be a service the hospital would be required to charge for.

“The point is not to charge the patient,” said Rattner, who is also chair of Local Health Information Network, Region 7, which covers 19 health-care facilities in the downtown Toronto core. “We work more with the third-party requesters.” These include insurance companies and law firms requesting medical information.

While Rattner, who helped prepare Mount Sinai’s submission, said she supports the government’s commitment, she wants to see peer hospitals continue to work together on the issue of fees.

“We don’t mind being subject to review,” said Rattner. “But we do want to recommend that the current collaboration of the health information custodians have input in the fee recovery for that process.”

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