The Ontario Medical Association has written to government adviser Ed Clark to express doctors’ concerns that his mandate will compromise the privacy of patients’ health records through privatization.

Health Minister Eric Hoskins wrote to Clark Friday, asking the former TD banker, now government adviser on asset maximization, to evaluate eHealth Ontario and the province’s public and private digital health record-related assets.

The Star’s sources report that Hoskins is seeking Clark’s input in hopes of getting him to say that eHealth is worth what the government has spent on it, as a pre-emptive strike against a possibly negative auditor general report to come before the House rises in December.

And Hoskins said plainly Wednesday, “There will be no sale of eHealth, or its assets, or its intellectual property,” after much speculation to the contrary.

But Hoskins didn’t just ask Clark to put a price tag on eHealth, he’s also asking the former banker for guidance, and “recommendations related to how to maximize the value of these assets for Ontarians by improving how care is delivered, the patient experience in interacting with the health care system and, indirectly, through the economic value that is created for Ontario's economy.”

And the Ontario Medical Association (OMA) still has concerns about that. The association wrote to Clark Thursday to say doctors are worried about how the government’s recent legislative changes affect patient privacy, and about his mandate in eHealth.

“To be clear, Ontario’s physicians are very concerned about the sanctity of the information shared by their patients in the context of the physician-patient relationship,” the letter from OMA president Virginia Walley (pictured above) says. “And, we are worried about the recent effort of this Ontario government to gather massive amounts of patient data without appropriate controls and with little or no consent from patients.”

“To be absolutely clear, we are very concerned about any privatization that might occur without appropriate safeguards on patient data,” it says.

The letter states that, with informed consent, aggregated, de-identified patient data can be useful to health care, but the government has been moving away from that approach and requiring individual patient data instead.

The letter cites Bill 199, which updated the Personal Health Information Protection Act when it passed last spring, and Bill 41 the Patients First Act currently before the legislature. The OMA charges that the two pieces of legislation give government bureaucrats access to patient health records, something the health minister disputes.

“Further, the government is gathering data with little or no indication of its eventual use and without reassurance that there are appropriate government and oversight mechanisms in place — particularly informed consent,” Walley wrote.

Walley also criticized the state of digital records in Ontario.

“The blunt reality is that we do not currently have a functional eHealth system that benefits patient care, and it unclear to us how your mandate from Minister Hoskins will help encourage or support this,” she wrote.

Going forward, efforts should be focused on developing a “functional, practical, usable, and accessible Electronic Health Record across the continuum of care,” she wrote.

Meanwhile, the Ontario government isn’t only asking Clark for advice on eHealth — it’s already working with plenty of advisors on an “ehealth 2.0” strategy.

For the past two years, it’s been developing eHealth 2.0, described in the ministry’s 2015-16 annual report as “a major undertaking to refresh the province’s ehealth strategy and establish provincial ehealth governance.” It was expected to be formally approved in the Spring/Summer 2016. Deputy Minister Bob Bell is leading the effort via the eHealth Investment and Sustainment Board.

Hoskins has spoken briefly about what his goals are, which he calls"consumer-facing digital health," and has promised to speak more about in the coming weeks.

"(We) need to focus on patient and consumer-focused tools and services that enable direct access to health information and improved care, such as accessing an individual's own health records, booking physician appointments online, keeping track of medicines, renewing prescriptions electronically, accessing services and advice remotely, and more," he wrote, in his letter to Clark.

In the process of developing the strategy, the ministry put an 18-month “pause” on hospitals, preventing them from acquiring new digital health record systems while a panel the board created — the Hospital Information System Renewal Panel — worked on a report and recommendations.

That report, completed in August, found that Ontario’s hospitals’ first generation of health information technology is a “fragmented” collection of systems, bought from different vendors.

Hospital Information System “investments to-date have provided hospital-specific improvements in service quality and efficiency, but from a system perspective, it has also generated duplication of effort and resources across hospitals, and a lack of standardization,” the report says.

Most hospitals require a next generation of systems and the panel is recommending hospitals work together in clusters to keep costs down, and minimize the number of different systems in use in the province, so that health records can be more easily integrated, and connected with the province's other health records systems and records held by patient's primary physicians.

OMA airs health records privacy concerns in open letter to Ed Clark

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