Running head: IMPACT OF PHIPA ON NURSING PRACTICE

Reflection of Personal Health Information Protection Act on Nursing

Davinder Bassi
XXX XXX XXX
NURS 217
Professor X
February 10, 2015
Humber ITAL

IMPACT OF PHIPA ON NURSING

Nursing practice is a field that is constantly evolving. The multitude of healthcare

advances in science and technology has made this inevitable. However, legislation for these
advancements has not been quite as fast. The collection and sharing of patient information in
order to provide timely medical care is a concern for many. In 2008, Roch stated two thirds of
Canadian citizens believe that personal health information is one of the most important areas in
need of protection under privacy laws (as cited by Potter & Perry, 2010, p.240). Ontario passed
the Personal Health Information Protection Act (PHIPA) in 2004 to help protect and safeguard
the security and confidentiality of a persons health information (Perry, Hockenberry,
Lowdermilk, & Wilson, 2013). PHIPA has altered nursing practice considerably, as nurses
continue to demonstrate regard for privacy and confidentiality in novel situations (CNO
Ethics, 2009, p.8). In this discussion, I will highlight some attributes of PHIPA and reflect upon
the impact this legislation has had on nursing practice and myself.
The Personal Health Information Protection Act sets out rules for the collection, use and
disclosure of personal health information (Cavoukian, 2004, p.5). PHIPA deals only with oral or
written information about the individual. These rules are applied to anyone who is a healthcare
custodian or their agent (Cavoukian, 2004). They must maintain security of all personal
health information obtained during treatment. Another important aspect of PHIPA is obtaining
express consent prior to information disclosure although emergency situations are permitted for
implied consent (Cavoukian, 2004). PHIPA also outlines a process for individuals to access their
personal health information and the right to correct inaccuracies. If a correction is not
satisfactory, the individual is entitled to complain to the Information and Privacy Commissioner
(IPC) (Cavoukian, 2005). The IPC play(s) a significant role in enforcing overall compliance
which, in turn, impacts nursing practice (Cavoukian, 2005, p.36).

IMPACT OF PHIPA ON NURSING

Nurses are considered health information custodians by PHIPAs definition, as they fall
under the category of healthcare practitioners (Cavoukian, 2005, p.6). While providing
healthcare services, they must ensure that all personal health information is kept private and
confidential. Working in a fast-paced environment, as most nurses are, they have had to become
more vigilant than ever, in protection of health information. Potter and Perry (2010) state a
nurses duty is to not share confidential information with anyone else except on a need-to-know
basis. That is, those directly involved in the individuals circle of care, solely for the purpose of
medical treatment (Cavoukian, 2005). Furthermore, the College of Nurses of Ontario (CNO)
incorporates and upholds this legislation through many of its Practice Standards and Guidelines
(CNO, 2008; CNO, 2009; CNO, 2014). Nurses must be aware of the clients right to privacy and
confidentiality, regardless of ethical conflicts that may develop (CNO, 2009). Practice is
impacted when a nurse cannot inform a clients family of a terminal illness (Potter & Perry,
2010). Likewise, if a client is HIV-positive and has not told their spouse, nurses can only advise
their client to do so, not inform the spouse (CNO, 2009). PHIPA does however allow a nurse to
breach confidentiality if required by law (with subpoena) to disclose information to a third party
or when the life, safety, or health of the client or innocent third party is at stake (ie. to report
suspected child abuse) (Potter & Perry, 2010). However, under PHIPA, some hospitals have now
developed their own procedure for releasing information to the police that must be complied
with. Nursing practice is also impacted by PHIPA with regards to documentation, as retention
and destruction of confidential information must follow appropriate policies and procedures to
ensure confidentiality (CNO, 2008). At my workplace, any identifiable personal health
information must be disposed of in shredder boxes provided, not in garbage or recycling bins.
For those nurses who work independently, the CNO has set practice guidelines following PHIPA

IMPACT OF PHIPA ON NURSING

on how health records should be managed when nurses stop practicing (retire) or die (CNO,
2014, p.3). These are just a few examples of the adaptations nurses have made following the
enactment of PHIPA in 2004.
Since I have worked in a tertiary healthcare setting (primarily acute care) as a clerical
associate for over 20 years, I have seen firsthand the effect of PHIPA on departmental
procedures. Most importantly for me, was to abstain from disclosing patient information over the
phone. At times, families became very frustrated; however, I always took the time to explain the
reason to alleviate some of it. Nursing staff, I noticed, began scheduling more family meetings
on the unit, instead of over the phone. By requesting family or the substitute decision maker to
come in person, verification of that person was ensured in the patients circle of care while
maintaining said confidentiality. Currently, we ask each patient upon admission, for written
consent to disclose information to family members who may call enquiring about them. The
Consent for Disclosure form is also signed for every fax we send with personal health
information since 2004. We have also reallocated patient charts to a more controlled area to
restrict accessibility thus, ensuring a higher level of privacy and confidentiality. As a nursing
student, PHIPA meant I could not attend clinical rotation until I signed a confidentiality
agreement. Legislation is enforced by hospitals via terminating employment and taking measures
to ensure future breaches are prevented and the public is protected. This was the case at Rouge
Valley Centenary Hospital in Scarborough when 2 employees provided information of 14,450
new mothers to companies selling registered education savings plans (Eastwood, 2014).
In conclusion, PHIPA has impacted both myself and nursing practice in significant ways.
By developing a trusting therapeutic nurse-client relationship, personal health information shall
be obtained. All nurses must comply with CNO Standards and Guidelines to maintain privacy

IMPACT OF PHIPA ON NURSING

and confidentiality of this information in every manner possible. Consequently, we shall be
upholding PHIPA, becoming leaders in our field, and enhancing the trust of the public in nurses
as well as their practice. This, too, is my goal as a future nurse.

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6
References

Cavoukian, Ann. (December 2004). A Guide to the Personal Health Information Protection Act.
Retrieved from https://www.ipc.on.ca/images/Resources/hguide-e.pdf
Cavoukian, Ann. (February 2005). Frequently Asked Questions: Personal Health Information
Protection Act. Retrieved from https://www.ipc.on.ca/images/Resources/hfaq-e.pdf
College of Nurses of Ontario. (2008). Documentation. Retrieved from
http://www.cno.org/Global/docs/prac/41001_documentation.pdf
College of Nurses of Ontario. (2009). Ethics. Retrieved from
http://www.cno.org/Global/docs/prac/41034_Ethics.pdf
College of Nurses of Ontario. (2014). Independent Practice. Retrieved from
http://www.cno.org/Global/docs/prac/41011_fsIndepPrac.pdf
Eastwood, J. (2014, August 27). Rouge Valley hospital privacy breach expands to affect 14,450
patients. Toronto Star. Retrieved from
http://www.thestar.com/news/gta/2014/08/27/rouge_valley_hospital_privacy_breach_affe
cts_6000_more_patients.html
Perry, S., Hockenberry, M., Lowdermilk, D., & Wilson, D. (2013). Maternal Child Nursing
Care in Canada. Toronto: Elsevier Canada.

Potter, P., & Perry, A. (2010). Canadian Fundamentals of Nursing Revised Fourth Edition.
Toronto: Elsevier Canada.