Midterm

Question 1

What did the constitution act of 1867 establish?

Answer 1

Established provincial responsibility for maintaining and managing hospitals, asylums, charities and charitable institutions. The federal government had jurisdiction over marine hospitals and quarantine.

Question 2

How was healthcare in Canada done pre WW2?

Answer 2

Health care in Canada was mostly privately delivered and funded

Question 3

What happened in 1947 (health care wise)?

Answer 3

Saskatchewan introduced a province-wide universal hospital plan, other provinces followed shortly after

Question 4

What happened in 1962 (health care wise)?

Answer 4

Saskatchewan introduced a universal, provincial medical insurance plan to provide doctors’ services to residents.

Question 5

What was the Medical care act of 1966?

Answer 5

The federal government passed the Medical Care Act in 1966 offering reimbursement/cost-sharing with the provinces for medical services by a doctor outside of a hospital. Within 6 years all provinces and territories had a universal plan

Question 6

What is the Canada Health act of 1984?

Answer 6

• Establishes criteria and conditions for health insurance plans that must be met by provinces and territories in order for them to receive full federal cash transfers in support of health
• Provinces and territories are required to provide reasonable access to medically necessary hospital and doctors’ services
• Primary objective of Canadian health care policy is “to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers”

Question 7

What do the 5 Canada Health Act principles provide for?

Answer 7

1. Public Administration
2. Comprehensiveness
3. Universality
4. Accessibility
5. Portability

Question 8

What is the public administration principle in the Canadian Health Act?

Answer 8

Health insurance plans need to be delivered by and operated by someone who is accountable to the provincial/territorial government and it needs to be done on a non profit basis.

Question 9

What is the comprehensiveness principle in the Canadian Health Act?

Answer 9

All medically necessary services provided via hospital, medical practitioners and dentists working in a hospital setting needs to all be covered under the health insurance plan.

Question 10

What is the universality principle in the Canadian Health Act?

Answer 10

Must allow all ensured persons to health coverage on uniform terms and conditions meaning that coverage can’t be drastically different (one province covering one thing and another something else). Needs to be uniform across the country.

Question 11

What is the accessibility principle in the Canadian Health Act?

Answer 11

Has to provide all ensured persons to reasonable access to medically necessary hospital and physician services without financial or other barriers. Doesn’t matter if in urban centre or rural area need access to medically necessary services

Question 12

What is the portability principle in the Canadian Health Act?

Answer 12

Needs to cover everyone when they move to another area of Canada or travelling (some limits and approval when travelling abroad). Need portability in Canada. Should be able to leave one area and go to another and have the same access to care no matter where you are.

Question 13

What are the 5 roles of provincial governments in health care?

Answer 13

• Administration of health insurance plans
• Planning and funding of care in hospitals and other facilities
• Services provided by doctors and other health professionals
• Planning and implementation of health promotion and public health initiatives
• Negotiation of fee schedules with health professionals

Question 14

What are primary, secondary and additional health services?

Answer 14

• Primary – first point of contact (could be hospital or urgent care settings or our regular checkups to the doctor)
• Secondary – a little bit more specialized. A referral to a specialist is an example.
• Additional – do not fall under our universal health insurance plan and are typically funded privately through our income our extended health plans. These services are all of the services that don’t fall under the universal health insurance plan.

Some might fall into multiple categories. E.g., a physio visit in a hospital vs private clinic

Question 15

How many regulated health professions are there?

Answer 15

29 distinct professions and 26 regulatory colleges

Question 16

What is the Ontario Regulated Health Professional Act of 1991?

Answer 16

The legislation that governs Ontario’s regulated health professions’ Colleges.

• Professions also have their own professional statutes, e.g., Physiotherapy Act, 1991, that lay out additional, individual definitions, scopes of practice, and authorized acts.
• The RHPA and associated health profession Acts, set out the governing framework for regulated health professions in Ontario.
• Responsible for ensuring that regulated health professionals provide health services in a safe, professional and ethical manner. This includes:
  o Setting standards of practice for the profession
  o Investigating complaints about members of the profession and, where appropriate, disciplining them

Question 17

What are the 5 key features of the RHPA?

Answer 17

1. Scope of practice - a statement that describes what the profession does
2. Controlled acts - procedures/activities which may pose a risk to the public id not performed by a qualified practitioner.
3. Health regulatory college - a corporation that governs each regulated health profession responsible for regulating the practice of the profession and governing its members according to the RHPA
4. Health professions regulatory advisory council - an independent, arms-length advisory body to the Minister of Health and Long-term Care with a mandate to advise the Minister of a number of items related to the regulation of health professions
5. Health profession appeal and review board - an independent 3rd party with a mandate to review registration and complaints decisions of the health regulatory college.

Question 18

What is the Health Professions Procedural Code?

Answer 18

Set out a comprehensive set of rules that all regulatory colleges must follow when:
* Registering new members
* Investigating complaints
* Disciplining members of the profession

The code is embedded into each health profession act.

These rules ensure that health professional regulation in Ontario is open, transparent, accessible and fair for:
* Those seeking to become regulated health professionals
* The regulated health professionals who are governed by the health regulatory colleges
* The patients and members of the public, whom the legislative framework is meant to protect

Question 19

What are the features of The Health Professions Procedural Code?

Answer 19

• Registering members
• Handling complaints
• Carrying out discipline hearings
• Handling fitness to practice hearings
• Quality assurance programs
• Patient relations program
• Mandatory reporting
• Funding for victims of sexual abuse by members
• Appeal processes regarding registration and complaint decisions

Question 20

What are the 14 controlled acts in Ontario?

Answer 20

1. Communicating a diagnosis or disorder as the cause of symptoms
2. Performing a procedure on tissue below the dermis, the surface of a mucous membrane, in or below the surface of the cornea, or in or below the surfaces of the teeth, including scaling of the teeth
3. Setting or casting a fracture of a bone or dislocation of a joint
4. Moving the joints of the spine beyond the individuals usual physiological range of motion using a fast, low amplitude thrusts
5. Administering a substance by injection or inhalation
6. Putting an instrument, hand or finger
   * beyond the external ear canal,
   * beyond the point in the nasal passages where they normally narrow,
   * beyond the larynx,
   * beyond the opening of the urethra,
   * beyond the labia majora,
   * beyond the anal verge, or
   * into an artificial opening into the body.
7. Applying or ordering the application of a form of energy prescribed by the regulations under this Act.
8. Prescribing, dispensing, selling or compounding a drug as defined in the Drug and Pharmacies Regulation Act, or supervising the part of a pharmacy where such drugs are kept.
9. Prescribing or dispensing, for vision or eye problems, subnormal vision devices, contact lenses or eye glasses other than simple magnifiers.
10. Prescribing a hearing aid for a hearing impaired person.
11. Fitting or dispensing a dental prosthesis, orthodontic or periodontal appliance or a device used inside the mouth to protect teeth from abnormal functioning.
12. Managing labour or conducting the delivery of a baby.
13. Allergy challenge testing of a kind in which a positive result of the test is a significant allergic response.
14. Treating, by means of psychotherapy technique, delivered through a therapeutic relationship, an individual’s serious disorder of thought, cognition, mood, emotional regulation, perception or memory that may seriously impair the individual’s judgement, insight, behaviour, communication or social functioning.

Question 21

What does a professional association do?

Answer 21

• Promote and advocate for the profession and professionals
• In some circumstances they may certify members
• Not overseen directly by a framework that is overseen by the government

Question 22

What 6 things does COKO do?

Answer 22

1. Setting requirements to enter the profession so that only qualified individuals can practise kinesiology.
2. Maintaining on its website a list of individuals qualified to practise kinesiology, known as the public register, or Find a Kinesiologist.
3. Developing rules and guidelines for kinesiologists’ practice and conduct, including a code of ethics.
4. Investigating complaints about kinesiologists’ practice and disciplining when necessary.
5. Current discipline cases & completed discipline case summaries are PUBLIC
6. Requiring kinesiologists to participate in a quality assurance program to ensure that their knowledge and skills are up-to-date.

Question 23

What is the COKO council?

Answer 23

The college is run by a Council, similar to a board of directors
* 10 kinesiologists are elected by their peers from across the province 3 yr term
* Between 6-8 public members are appointed to the Council by the Ontario Government

Council directs a staff team lead by the registrar of the college

Council meets a minimum of 4 times a year

Question 24

What is the COKO executive committee?

Answer 24

The executive committee is made up of council members specifically and this is if council can’t meet as a whole they would step in to make executive decisions in the event that an emergency decision needs to be made.

Question 25

What are the CKO standards?

Answer 25

The standards and guidelines are based on the essential competencies of practice for kinesiologists of Ontario. Essential competencies define the knowledge, skills, judgments and attitudes that are required to practice in the public interests.

• Advertising
• Supervision & education of students & support personal
• Conflict of interest
• Code of ethics
• Consent
• Discharging a client
• Dual health care
• Fees & billing
• Infection control
• Professional boundaries
• Professional collaboration
• Record keeping
• Sexual abuse

Question 26

What are some areas of kinesiology practice?

Answer 26

• health promotion
• Injury rehabilitation
• chronic disease management
• ergonomics and workplace safety
• fitness and athletics
• return to work planning and disability management
• public health

Question 27

What is the kinesiology scope of practice?

Answer 27

“the assessment of human movement and performance and its rehabilitation and management to maintain, rehabilitate or enhance movement and performance.”

Question 28

What is clinical, non-clinical and mixed practice?

Answer 28

Clinical practice - means that you are using the essential competencies of kin to provide direct service/care to clients

Non-clinical practice - involves using the essential competencies of kin outside the provision of direct service/care to clients

Mixed practice - means that you work in a non-clinical role and provide direct service/care

Question 29

What is ethics?

Answer 29

Ethics is a set of moral values that an individual establishes for oneself and your own personal behavior.

Looks at rules of conduct

Question 30

What is law?

Answer 30

• The systematic set of universally accepted rules and regulation created by an appropriate authority such as government, which may be regional, national, international, etc.
• It is used to govern the society and the action and behavior of its members and can be enforced, by imposing penalties.

govern all of society rather than a single individual or group

Question 31

What is professional ethics?

Answer 31

• Professional ethics improve professional service and assist with public confidence
• The public puts its trust in individual professionals AND professional groups. They rely on the group to guarantee that its members fulfill their agency obligations
• Professional ethics are similar to values in that they provide rules on how a person should act towards other people and institutions that are in the specified environment that they are set out in.
• Ensure we fulfill our obligations

Question 32

What are the 5 parts of the COKO Code of Ethics

Answer 32

1. Respect
2. Excellence
3. Autonomy & well-being
4. Communication, collaboration & advocacy
5. Honesty & integrity

Question 33

COKO ethics - respect

Answer 33

Members are respectful of the differing needs of each individual and they honour the patients right to privacy, confidentiality, dignity and treatment without discrimination.

Question 34

COKO ethics - excellence

Answer 34

Members are committed to excellence in professional practice through continued development of knowledge, skills, judgements and attitudes.

Question 35

COKO ethics - Autonomy and well-being

Answer 35

Members are at all times guided by a concern for patients well being and the fact that patients have a right to self-determination and are empowered to participate in decisions about their health-related quality of life and physical functioning.

Question 36

COKO ethics - Communication/collaboration and advocacy

Answer 36

Members having value in the contribution of all individuals involved in the health care allocation. Communication/collaboration and advocacy are essential to achieve the best possible outcomes in any situation.

Question 37

COKO ethics - Honesty/integrity

Answer 37

Demonstrated by each members commitment to behave with honesty and integrity. Fundamental to any delivery of high quality, safe and professional services.

Question 38

What are the 5 steps to making an ethical decision?

Answer 38

1. Recognize - there is an ethical issue or something is making you uncomfortable
2. Identify - what is the problem & who is involved
3. Consider - facts, laws, principles & values
4. Take action & implement - are there barriers? What info should be recorded?
5. Evaluate - what was the outcome & is further action needed? What did you learn and how can you prevent future occurrences?

Question 39

What is reflective practice?

Answer 39

o As one’s professional identity is developed, there are aspects of learning that require understanding of one’s personal beliefs, attitudes and values, in the context of those of the professional culture

o To learn effectively from one’s experience is critical in developing and maintaining competence across a practice lifetime
o Building integrated knowledge bases requires an active approach to learning that leads to understanding and linking new to existing knowledge
o Taken together, these capabilities may underlie the development of a professional who is self-aware, and therefore able to engage in self-monitoring and self-regulation

Question 40

What is clinical reasoning?

Answer 40

A skill, process, or outcome wherein clinicians observe, collect, and interpret data to diagnose and treat patients

Need info from a variety of areas to do so:
o Collect a thorough description of the problem or concern
o Apply appropriate testing measures
o Evaluate and utilize evidence-based practices
o Have a thorough understanding of the healing process for injured tissue and optimal performance
o The client & their overall goals

• When we apply clinical reasoning it supports our reflective practice and growth while creating a more positive experience for our clients.

Question 41

What are 5 reasons to complain about a kin?

Answer 41

o ignored the basic rules of practice;
o sexually abused a patient/client;
o not maintained the standards of practice;
o provided inappropriate care/service;
o a physical or mental condition or disorder that interferes with their ability to practice.

Question 42

What is an inquiry?

Answer 42

Relates to issues of incapacity
- If a member is suffering from a physical or mental condition that makes it desirable in the interest of the public that their certificate of registration be subject to terms, conditions or limitations, or that they not be permitted to practice

Question 43

What is a complaint?

Answer 43

Expression of concern regarding a member by one or more complainants

o The college cannot investigate anonymous complaints
o There is no time limit to file a complaint
- must be written or recorded
- The complainant and member are participants to proceeding

Question 44

What is a report?

Answer 44

information received by the College from any source regarding a members professional misconduct or incompetence
o Mandatory reports (e.g. by self, employer, fellow health professional) regarding conviction, sexual abuse, termination, loss of privileges
o Other reports (e.g. media, other health professionals, members of public, etc.)

Question 45

What is the complaints process?

Answer 45

After a complaint has been filed:
* College staff will contact the complainant within 14 days of receiving the complaint to confirm they have received the documentation.
* A College investigator will be appointed to investigate the matter and collect information
* The kinesiologist receives a copy of the complaint and have an opportunity to respond in writing (shown to council members reviewing complain and complainant)
* Information collected will be reviewed by the Inquiries, Complaints and Reports Committee (ICRC). The panel includes kinesiologists and members of the public.

Question 46

What are the 7 ICRC decisions?

Answer 46

o Refer the matter to the College’s Discipline Committee
o Refer the matter to another panel of the college
o Issue a caution to the kinesiologist
o Require the kinesiologist to complete programs that will improve their practice.
o Issue written advice with or without recommendations
o Enter into an agreed upon undertaking with the kinesiologist that outlines things he/she must do
o Decide that no further action is required

Both the complainant and the kinesiologist have the right to appeal the ICRC’s decision to the Health Professions Appeal and Review Board (HPARB) if they feel the investigation was inadequate or the decision was unreasonable.

Question 47

What 4 things can the ICRC not do?

Answer 47

o Award complainants any monetary compensation (for any damage)or other compensation.
o Require the kinesiologist to apologize to the complainant.
o Require another administrative body or organization to change a decision regarding the subject matter of the complaint (e.g. an insurance company changing the provision of benefits).
o Require an employer to discipline a kinesiologist.

Question 48

What can the public see after a complaint?

Answer 48

Posted on the Public Register
o Referrals to Discipline, including information about the allegations and the hearing
o Cautions
o Specified Continuing Education or Remediation Program (SCERP) - posted but limited info
o Undertakings
o Terms, Conditions, Limitations
o Suspensions

Not Posted on the Public Register
o Practice Advice
o No Action

Question 49

Ethical vs legal complaints

Answer 49

Not all ethical complaints will result in legal action however, any legal action taken against you will result in ethical investigations from your professional organizations.

Question 50

What is liability?

Answer 50

• You will always be held accountable for your actions
• You are liable for all actions that you perform (or do not perform) when you are working in a health care capacity
• The term ‘Liability’ refers to being legally responsible for the harm you cause another person
• You must always take great care in following procedures to prevent harm to others thereby reducing the risk of being sued
• In Ontario, the statute of limitations is 2 years
  This legal action is tied in court by tort law.

Question 51

What are torts?

Answer 51

• Torts are legal wrongs committed against the person or property of another It is expected that you will “first do no harm” to others
• Tort law provides damages to victims as compensation for their losses
• Under legal obligation to ensure reasonable care to ensure others will not be injured because of careless conduct
• When injury occurs, either intentionally or by negligence, they can be required by a court to pay money to the injured party.
• A tort: is a wrongdoing done to an individual that is not a breach of contract, where monetary damages are sought. The most common tort in health care is negligence

Question 52

Intentional vs unintentional tort

Answer 52

Intentional Tort: Battery and Assault are examples

Unintentional Tort: Negligence

Question 53

3 types of legal wrongs

Answer 53

Nonfeasance (act of omission): Failure to perform your legal duty

Malfeasance (act of commission): Individual commits an act that is not legally theirs to perform

Misfeasance (act of commission): An individual improperly does something that he or she has the legal right to do

Question 54

What is negligence and the 4 things needed to establish it?

Answer 54

Negligence: the failure to use ordinary or reasonable care
- Care that persons would normally exercise to avoid injury to themselves or others under similar circumstances

1. A duty of care existed between the injured person and the person responsible for that injury
   2.The defendant breached this duty by conduct that fell short of the standard of care
   3.The defendant caused the injury to occur
   4.Personal, property, or punitive damages resulted

Question 55

How can we reduce the risk of litigation?

Answer 55

• Establish trust of athletes/parents/guardians
• Establish policies/guidelines
• Develop, review your EAP
• Be familiar with the health status of your athletes
• Work within your scope
• Work within your ethical guidelines
• Obtain consent
• Documentation

Question 56

What is the Ontario Health Care Consent Act (HCCA), 1996?

Answer 56

• HCCA: is a legal framework on establishing, maintaining and recording valid consent
• “Promote communication and understanding between health practitioners and their patients or clients”
• By providing patients/clients with all of the necessary information regarding their condition and treatment options, a practitioner is including the patient/client in the process, thereby strengthening the efficacy of the therapeutic relationship and the autonomy of the patient/client
• Looks at where and when consent is obtained. What happens If the person is deemed incapacitated.

Question 57

What are the 3 times we need consent?

Answer 57

Any time treatment occurs, any time we have admission to any care facility and any time we have the need for personal assistive services.

Treatment = anything that is done for therapeutic, preventative, palliative, diagnostic, cosmetic or other health related purpose. It includes a course of treatment, a plan of treatment or community treatment plans.

Question 58

What 4 things need to happen with consent?

Answer 58

1. The consent you are asking the patient for must relate to the treatment.
2. Must be informed
3. Must be voluntary
4. Consent must not be obtained through misrepresentation or fraud.

Question 59

What 6 things need to be discussed for consent to be informed?

Answer 59

• The nature of the treatment
• The expected benefits of the treatment
• The material risks of the treatment
• The material side effects of the treatment
• Alternative courses of action
• The likely consequences of not having the treatment

Informed consent is based on information which a reasonable person in the same circumstance as the patient would require in order to make a decision about their treatment.

Question 60

What do we need to be aware of for voluntary consent?

Answer 60

• A patient/client’s consent to care is their individual choice. It should be made freely without any pressure from another individual.
• Health practitioners need to be aware of the influence they have over patients/clients
• Practitioners must also ensure that other representatives are not pressuring a patient/client
• Consent can be withdrawn at any time

Question 61

Implied vs expressed consent

Answer 61

Implied = Inferred from signs, actions, or facts or by inaction or silence. Is subject to interpretation, which can lead to misunderstanding

Expressed = Explicitly provided directly from the patient/client or SDM
- Can be either verbal or written

When someone is in an emergency situation and are unconscious so the idea is that if they were conscious they would want you to help them therefore we can imply their consent in that case.

Question 62

Who can provide consent?

Answer 62

• All persons are presumed to be capable
• The individual must understand the information that is relevant to make a decision about the treatment and is able to appreciate the reasonably foreseeable consequences of a decision or lack of a decision
• Practitioners have a duty to adjust to ensure the patient/client receives all information necessary to provide informed consent.
• The mere existence of a psychiatric or neurological condition does not make an individual lack capacity. Similarly just b/c someone refused services that you believe are the appropriate steps this doesn’t make someone lack capacity.
• Just b/c someone requests alternative services does not make them lack capacity.
• A person’s age also does not explicitly make them lack capacity whether they are young or older.
• The existence of a disability (visual, hearing or speech) the presence of that on its own does not make an individual lack capacity.
• If a substitute decision maker is in your presence that does not explicitly on its own that the patient in front of you lacks capacity. Still must determine if capacity exists.
• How complex (the nature of it or if it comes with risks) what we are offering is might escalate or deescalate this idea of capacity.

Question 63

What are some things that can lead to incapacity?

Answer 63

What might make a patient incapable? Possible indicators include perhaps they’ve demonstrated that they are confused or are delusional in their thinking. Maybe they appears unable to make a settled choice about a service (going back and forth and lack ability to think through that process). Maybe experiencing pain, acute fear or anxiety. In that moment they aren’t in an appropriate state to make a decision and weigh out the options and consequences. When a person appears to be severely depressed. Similar to the last point they may be in a moment where they lack the ability to truly make decisions in the best interests of their own health. The idea or presence of impairment due to drugs/alcohol – interesting when we talk about patient medication such as pain mediators that are prescribed or pain mediators that may be utilized that aren’t prescribed that we can get freely (such as cannabis).

Question 64

What to do if you suspect incapacity?

Answer 64

*Inform the patient/client in a manner that they are best able to understand
oIdentify your belief that they are unable to consent to proposed care at this time but that this does not mean they cannot consent to other matters

*Document
oThorough documentation of the conversation should occur in their health record
oThey must be informed this will be documented

*If there is a substantial risk of serious harm or they are unable to understand the fact of the finding &/ the practitioner reasoning, then the patient does not need to be directly informed

Question 65

What are the 2 reasons we don’t need to tell someone they lack capacity?

Answer 65

The first time is if there is a substantial risk to serious harm to both the patient and to you and others around you if you say that the individual lacks capacity.

The second one is when the incapacity is to such a state or such a degree that they wouldn’t be able to understand the fact of finding or your reasoning.

Question 66

How should we document consent?

Answer 66

Is a signature on its own isn’t conclusive evidence that a discussion took place?

• Even if you ask them to sign a statement that outlines risks/benefits this isn’t necessarily explicitly indicating that consent took place b/c consent is ongoing.

Question 67

What are the 2 federal laws that govern general privacy?

Answer 67

1. Privacy act
2. Personal Information protection and Electronic Documents Act (PIPEDA)

Question 68

What is the privacy act?

Answer 68

Relates to a person’s right to access and correct personal info that the Canadian government holds about them.

Also applies tot he governments collection, use and disclosure of personal info in the course of providing services.

Question 69

What is the Personal Information protection and Electronic Documents Act?

Answer 69

Sets the ground rules of how private-sector organizations collect, use and disclose personal info in the course of for-profit and commercial activities across Canada.

Question 70

What are the two general privacy laws in Ontario?

Answer 70

1. Freedom of Information and Protection of Privacy Act (general public sector)
2. Municipal Freedom of Information and Protection of Privacy Act (municipal governments).

Question 71

What is the Personal Health Information Act (2004)?

Answer 71

• Ontario’s health privacy legislation Enforced by the Information and Privacy Commissioner of Ontario
• Establishes a set of rules regarding personal health information
  *The privacy legislation is intended to :
  o Protect the confidentiality, privacy and security of Ontarians’ personal health information;
  o Improve quality of care for patients;
  o Provide health care practitioners with the right information at the right time;
  o Provide a framework that supports broader health care reforms that will modernize Ontario’s health care system such as Smart Systems for Health;
  o Balance the need to share information in the health sector while protecting individuals’ health information privacy;
  o Achieve better health system integration;
  o Enable improved health system management, performance measurement, and fraud prevention; and,
  o Maximize the benefits of new health technologies.

Question 72

What are patient rights under PHIPA?

Answer 72

• be informed of the reasons for the collection, use and disclosure of your personal health information;
• be notified of the theft or loss or of the unauthorized use or disclosure of your personal health information;
• refuse or give consent to the collection, use or disclosure of your personal health information, except in certain circumstances;
• withdraw your consent by providing notice;
• expressly instruct that your personal health information not be used or disclosed for health care purposes without your consent;
• access a copy of your personal health information, except in limited circumstances;
• request corrections be made to your health records;
• complain to our office if you are refused access to your personal health information;
• complain to our office if you are refused a correction request;
• complain to our office about a privacy breach or potential breach; and
• begin a proceeding in court for damages for actual harm suffered after an order has been issued or a person has been convicted of an offence under PHIPA.

Question 73

What is personal health info?

Answer 73

Personal health information is defined as information that can identify an individual (or can be combined with other information to identify an individual)

• PHIPA also covers mixed records that contain both personal health information and other non-health identifying information about an individual

Question 74

What are PHI examples?

Answer 74

• the physical or mental health of the individual (including family health history);
• the provision of health care to the individual (including identifying the individual’s health care provider);
• home and community care;
• payments or eligibility for health care or coverage for health care;
• the donation or testing of an individual’s body part or bodily substance;
• the individual’s health number; or
• the identification of the individual’s substitute decision-maker.

Question 75

What are our 6 obligations under PHIPA?

Answer 75

1. to obtain CONSENT to collect, use or disclose an individual’s personal health information
2. to maintain SECURITY over personal health information by taking reasonable steps to protect against theft, loss and unauthorized use or disclosure (this includes an audit log for electronic health records and maintaining security on electronic devices, for example by encrypting data
3. to ensure the ACCURACY of personal health information
4. to collect, use or disclose ONLY AS MUCH personal health information as IS NECESSARY in the circumstances
5. to provide individuals with ACCESS to their personal health information upon request - unless part of legal proceeding or it’s dangerous to do so.
6. to CORRECT personal health information if the record is incomplete or inaccurate (except where one is not in a position to correct the information in a record created by another custodian or if the information consists of professional opinion or observation made in good faith).

Question 76

When can we use PHI without consent?

Answer 76

• When you are using info for the purpose for which it was already collected
• if you are required by Lea to disclose it
• for risk/error management or to improve the quality of care
• to educate agents who provide health care
• For purposes involving disposing of or modifying the info to conceal the identity of the individual
• when your purpose is to obtain consent for a legal proceeding, to obtain payment for healthcare, for research (subject to certain conditions) or if permitted and/or required by law

Question 77

When is it okay to disclose PHI without consent?

Answer 77

• if an individual has provided religious affiliation, consent may be implied to disclose an individual’s name and the name and location in the health care facility to a religious representative
• a pharmacist may disclose PHI to a 3rd party who is being asked to provide payment for meds or related goods
• when disclosure is to provide further health care
• when disclosure is related to a deceased individual
• to mitigate risks
• for proceedings
• when PHI is given to a successor
• for research approved by the ethics board
• to monitor health care payments
• to analyze health care system
• if disclosure has been approved by the Commissioner

Question 78

What are some administrative measures to protect privacy?

Answer 78

• Confirm identity before providing access to PHI
• Limit access to PHI to a “need to know basis”
• Follow requirements to sign agreements to protect PHI
• Ensure PHI awareness and engage in training
• Strictly follow policies and procedures

Question 79

What are some Technological Measures to Protect Privacy?

Answer 79

• Ensure PHI is backed up and stored in a secure data center
• Use firewalls and encryption
• Don’t share or write down passwords
• Access controls

Question 80

What are your obligations when it comes to virtual care?

Answer 80

• Obtaining informed consent (documented) to the virtual encounter (e.g. risk, benefits, and alternatives with virtual care and the type of technology used);
• Meeting privacy and confidentiality requirements (e.g. physical and technical safeguards to protect personal health information and not using platforms that store recording encounters on the cloud or ‘offsite’ without College or employer approval);
• Maintaining proper and secure documentation and patient/client records (note: the same standards for documentation apply to both in-person and virtual care encounters);
• Ensuring positive patient/client and substitute decision maker identification (e.g. defined by your local protocol/guidelines);
• Complying with your duty of care responsibilities (e.g. providing the patient/client with adequate/appropriate information, use of language and cultural interpreters, timely consultations, etc.);
• Ensuring program and platform suitability (e.g. pros/cons of the platform, suitability to the patient/client and practitioner needs).

Question 81

What is a health custodian?

Answer 81

A person or organization who has custody or control of PHI as a result or in connection with performing the person’s or organization’s duties.

Ultimately responsible for the PHI in his or her custody or control, but may permit an agent to collect, use, disclose, retain or dispose of the info if certain requirements are met.

Question 82

What is a health agent?

Answer 82

With the authorization of the custodian, acts for or on the behalf of the custodian in respect of PHI for the purposes of the custodian, and not the agent’s own purposes.

Must ensure that the collection, use, disclosure, retention or disposal of the info is permitted by the custodian, is necessary for purposes of carrying out the agent’s duties, is not contrary to law and complies with any specific restrictions imposed by the custodian.

Question 83

Health info custodians can include:

Answer 83

• a health care practitioner (e.g., a physician) or a person who operates a group practice of health care practitioners
• long-term care homes
• Local Health Integration Networks, including those functions previously performed by community care access centres
• hospitals, including psychiatric facilities
• specimen collection centres, laboratories, independent health facilities
• Pharmacies
• ambulance services
• Ontario Agency for Health Protection and Promotion

Question 84

What are the 4 duties of a health custodian?

Answer 84

• to develop and comply with information practices
• to designate a contact person
• to display or make available a written public statement
• to notify ppl when privacy breaches occur.

Question 85

Express vs implied consent with collection, use, disclosure of PHI

Answer 85

Express consent is required where personal health information is disclosed to a person who is not a health information custodian (such as an insurance company) or it is not disclosed for the purpose of providing health care. Express consent is also required for certain fundraising, marketing and market research activities.

Implied consent is sometimes sufficient but not regularly advised. Health professionals can assume that they have implied consent to collect, use or disclose personal health information for the provision of health care if these conditions are met:
o the information was received from the individual, the individual’s substitute decision-maker or another health information custodian;
o the information was received for the purpose of providing health care to the individual;
o the information is collected, used or disclosed for the purpose of providing health care to the individual;
o if information is being disclosed, it must only be disclosed to another health information custodian;
o the individual has not withheld or withdrawn consent.

Question 86

When can we disclose PHI without consent?

Answer 86

• There are actually a few exceptions where PHI can be collected, used to disclosed without consent. These are - to collect PHI of an individual even if the individual is incapable of consenting if it is reasonably necessary to provide health care when consent can not be obtained in a timely manner. This is your emergency situation. To disclose PHI about an individual if the custodian believes on reasonable grounds that a disclosure is necessary for the purpose of eliminating or reducing significant risk of bodily harm. To disclose PHI in the context of a legal proceeding if the custodian/agent is a party or witness and the final piece is to disclose PHI to a regulatory college in the context of an investigation or complaint.

Question 87

What is a privacy breach and what must you do?

Answer 87

Personal health information has been stolen, lost, or used or disclosed without authority

• The health information custodian must notify the individual about whom the information relates at the first reasonable opportunity.
  o The notice has to inform the individual that he or she is entitled to make a complaint to the Information and Privacy Commissioner of Ontario.
• In serious situations the health information custodians will also have to notify the Commissioner immediately. The Commissioner also needs to be notified of all privacy breaches in an annual report filed with the Commissioner’s office.
• An agent that handled the information must notify the responsible health information custodian at the first reasonable opportunity.
• As a health info custodian you have additional reporting obligations if you are part of a regulatory college. Must notify your governing body (the college) that there was a privacy breach that occurred.
• Whenever you tell someone their info has been accessed you need to tell them they have a right to make a complaint with the information and privacy commissioner of Ontario. This MUST be done
• Need to tell the person, the commissioner and the privacy person.

Question 88

What are the consequences for a privacy breach?

Answer 88

If the privacy commissioner says you need to pay a fine, I as your patient can sue you in seeking damages b/c this info got out and it shouldn’t have.

• If a health professionals privacy breach (they disregarded PHIPA) if it’s deliberate the fine can be up to $200,000 and imprisonment for up to 1 year. Even if it’s not deliberate – not reporting it demonstrates covering it up b/c

Question 89

What are the Objectives of proper record keeping?

Answer 89

• To facilitate the safe and quality care and treatment of patients/clients.
• To ensure patients/clients have access to up-to-date, accurate information about their health.
• To ensure continuity of care for patients/clients from successive members or other treating health professionals.
• To ensure accountability to patients/clients, payors, the College, the profession and other healthcare providers.
• To demonstrate judgment, reasoning and adherence to the practice standards of the profession.
• To meet any other requirements mandated by the organizations they are associated with or where required by law.

Question 90

What 6 things must records be?

Answer 90

• Identifiable
• Legible and understandable
• Comprehensive
• Accurate and timely
• Accessible and retrievable
• Secure and confidential

Question 91

What are the performance expectations for records?

Answer 91

• Unique identifier used
• Sequential system
• Always dated
• Identity of the person who made the entry indicated
• Amendments or corrections clearly identify what was changed, why it was changed, date changed, and by whom. Original record cannot be destroyed
• Entry completed in a reasonable time period
• Legible
• Respectful language
• Audit trail

Question 92

What are equipment service records?

Answer 92

Contains servicing information for any instrument or equipment that requires regular servicing and is used by the member for the purpose of assessing, treating, or providing a service to a patient/client

Question 93

What are financial records?

Answer 93

• Contains information on bills for services and clinical products to the patient/client either billed directly or indirectly through a third party
• This includes
  o Patient’s/client’s name
  o Each treatment, service, or clinical product provided to the patient/client and the date provided
  o The fee charged or received relating to each treatment, service, or clinical product provided to the patient/client
  o Balance of account

Question 94

What is the S in SOAP?

Answer 94

Subjective - Symptoms the patient or caregiver verbally expresses. These descriptions provide a clinician with insight into the severity of a patient’s condition, the level of dysfunction, the injury progression and the degree of pain.

Question 95

What is O in SOAP?

Answer 95

Objective - Measurements that are observed (seen, heard, touched) by the clinical. E.g., ROM, strength, special tests, diagnostic testing.

Question 96

What is A in SOAP?

Answer 96

Assessment/Analysis - a prioritized list of assessed patient conditions. Potential differentials, pertinent pos or negative signs and symptoms related to the condition, reference to evidence based medicine goals, adjunctive lifestyle measures.

Question 97

What is P in SOAP?

Answer 97

Plan - The care plan action steps for the patient and health care practitioners. In addition to direct therapeutic interventions and home program info, this may also include lifestyle recommendations, standards of care, special directions, referrals, self-monitoring, emergency contacts, and time to follow-up appointments.

Question 98

How long must you hold onto documentation?

Answer 98

Patient/client health records:
- For patients/clients who are 18 years of age or older at the time of the last contact, a period of at least 10 years
- For patients/clients who are less than 18 yrs of age at the time of the last contact: a period of at least 10 years following the date at which the patient/ client would have become 18 years of age

Equipment service records must be retained for a min of 5 years

Question 99

What happens when we close or transfer a practice?

Answer 99

• Notify the patient/client is notified
• Provide information about future location of records provided
• Record must be transferred to another health information custodian and the patient/client is notified
• Ensure that records are stored or transferred securely

Question 100

What are special considerations with electronic privacy?

Answer 100

o A member may maintain an electronic record keeping system in accordance with this Standard.
o A member will take reasonable steps to ensure that the electronic record keeping system is designed and operated so that patient/client health records: are secure from loss, tampering, interference or unauthorized use or access; and will be retrievable and reproducible through the entire retention period.
o A member will ensure that the personal health information of patients/clients that is stored on any devices have the appropriate safeguards.

Question 101

What is cultural humility?

Answer 101

A process of self-reflection to understand personal and systemic biases and to develop and maintain respectful processes and relationships based on mutual trust. Cultural humility involves humbly acknowledging oneself as a learner when it comes to understanding another’s experience

Question 102

What is cultural safety?

Answer 102

An outcome based on respectful engagement that recognizes and strives to address power imbalances inherent in the health care system. It results in an environment free of racism and discrimination, where people feel safe when receiving health care

Question 103

What is intersectionality?

Answer 103

Belonging to more than 1 oppressed group

Question 104

What is unconscious bias?

Answer 104

Unconscious biases are social stereotypes about certain groups of people that individuals form outside their own conscious awareness

• Unconscious biases about people of other cultures or race and compliance stereotyping have been shown to negatively impact patient care, including poor patient-provider communication, poor communication among providers, patient mistrust of the healthcare system, and poor patient ratings of care
• Assumptions that we make before considering what is actually happening.

Question 105

What is Western medicine?

Answer 105

o Physically examining the body and the associated symptoms
o Diagnosing diseases and conditions using scientific evidence
o Using treatments that are clinically proven to be effective

complimentary/alternative is more preventative

Question 106

What is the HPARB?

Answer 106

health professions appeal and reveal board