Memorandum of Understanding Regarding an Approach to

7.12

such reasonable assurances and execute and deliver such further documents or instruments asmay be required or reasonably requested by the other parties, or which may be necessary ordesirable, in order to give full effect to and carry out the provisions of this MOU.

Effective Date. Thís MOU is the written memorandum and documentation of an agreemententered into between the parties on and as of the Effective Date. Notwithstanding the date onwhich this MOU has been signed, the parties agree that the terms and conditions of this MOUhave operated as between them and been effective as of the Effective Date.

7.13 Gounterparts. This MOU may be executed in counterparts, all of which taken together will bedeemed to constitute one and the same instrument. Delivery of an executed signature page tothis MOU by any party by facsimile or electronic transmission will be as effective as delivery of amanually executed copy thereof by such party.

lN WITNESS WHEREOF each of the parties has executed this MOU by its duly authorized representative(s)on the dates set forth below.

ALBERTA HEALTH SERVICES

Authorized Signature

Name

Position

Date

COLLEGE OF PHYSICIANS AND SURGEONS OF ALBERTA


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9

GOVERNORS OF THE UNIVERSITY OF ALBERTA


Name

Position

Date

ME loN

Authorized Sign

MName

tr.¡,ecua1ys ùrØe¿¡tllPosition

Zot\ lo, l+Date

GOVERNORS OF THE UNIVERSITY OF CALGARY


Name

Position

Date

10

Schedule “A” - Statement of Principles for an Approach to Information Sharing

AHSClinicalInformationSystemInformationSharingApproach StatementofPrinciples

ISFWorkingGroup 1of19

StatementofPrinciplesfor

AnApproachtoInformationSharingamongUsersof

AlbertaHealthServicesClinicalInformationSystems

June29,2017



Contents

Purpose........................................................................................................................................................3

Approach......................................................................................................................................................3

Scope............................................................................................................................................................4

AHSCISs....................................................................................................................................................4

AHSCISUses.............................................................................................................................................5

AHSCISUsers...........................................................................................................................................5

Objectives.....................................................................................................................................................5

PrinciplesofInformationSharing.................................................................................................................7

RolesandResponsibilities............................................................................................................................8

AHSCISInformationSharingCompact.......................................................................................................10

InformationManagementAgreement.......................................................................................................11

DataStewardshipServices.........................................................................................................................11

DataStewardshipConsolidation............................................................................................................11

DataStewardshipServices.....................................................................................................................11

DataStewardshipOperations................................................................................................................13

Governance................................................................................................................................................14

InformationStewardship.......................................................................................................................14

InformationStewardshipCommittees...................................................................................................14

Representation.......................................................................................................................................15

Accountability........................................................................................................................................15

DisputeResolution.................................................................................................................................15

Transitions..............................................................................................................................................16

Definitions..................................................................................................................................................17



Purpose

TheAHSProvincialClinicalInformationSysteminitiative(the“Program”)isacollaborativeeffortbetweenAlbertaHealth(“AH”),AlbertaHealthServices(“AHS”)andAHSstaff,cliniciansandpatientstoimprovehealthcareforAlbertans.AClinicalInformationSystem(“CIS”)isanintegratedinformationmanagementplatformenablingcollection,access,useandsharingofinformationsupportingthedeliveryofhealthcareservicestopersonsandpopulationsinmultiplesettingsacrossthecontinuumofcare.AHS,togetherwithotherhealthsectorstakeholders,includingtheAlbertaMedicalAssociation(“AMA”),theCollegeofPhysiciansandSurgeonsofAlberta(“CPSA”)andAlberta’sHealthcareEducationOrganizations,allrecognizetheimportanceofincorporatingCISsintotheplanninganddeliveryofhealthcareservicesforthepeopleofAlberta.

AHShasbeenchargedwithresponsibilityforimplementinganAHSProvincialCISwithinthedomainofitsfacilitiesandprogramssupportingthecareofpatientsthroughouttheProvinceofAlberta.ApprovedusersofthissystemgainaccessthroughasecuregatewaytoanonlineenvironmentwherethedigitalhealthrecordandsupportinghealthinformationsystemsareprovisionedandmanagedbyAHS.TheabilityoftheProgramtoimprovepatientexperiences,andthequalityandsafetyofpatientcare,however,iscontingentuponmeaningfulandconsistentusebyallhealthcareproviders.

Accordingly,thepurposeofthisStatementofPrinciplesistodescribethesharedcommitmentofProgramstakeholderstocollaborateandfostertheexchangeofHealthInformationwithintheAHSProvincialCIS,baseduponprinciplesofinformationstewardshipandgovernancethatpromotetransparencyandtrustamongparticipants.Stakeholdersincludehealthcareproviders,contractedandaffiliatedhealthserviceproviders,educators,researchers,leadersandadministrators.

ImplementationoftheAHSProvincialCISprovince-wideisexpectedtotakeplaceoverthecourseofmanyyears,replacingcurrentlyexistingCISs.ItisthereforethedesireoftheProgram’skeystakeholdersforthisStatementofPrinciplestoapply,notonlytotheanticipatedAHSProvincialCIS,butalsotoalloftheexistingAHSCISscurrentlyinusewithinAHSfacilitiesinordertoestablishconsistencyandpredictabilitywhiletheAHSProvincialCISisrolledoutacrosstheProvinceofAlberta.

WhileallpartiesrecognizetheimportanceofaligningtheirpoliciesandprocedurestocomplywiththeAlbertaHealthInformationAct(“HIA”),otherrelevantlegislation,healthprofessionalregulatorybodies,healthethicsandorganizationalpolicy;thepartiesalsowishtopromoteconditionsforCIS-facilitatedhealthcareimprovement,instruction,inquiryandinnovation.

Approach

Theexisting“InformationSharingFramework”(“ISF”),developedtofacilitatePhysicianadoptionofAHSambulatorycareEMRs,willbereplacedbyaninformationsharingapproachapplicabletoallAHSCISs,allparticipatinghealthcareprovidersandallsettingsacrossthecontinuumofcarewithintheProvinceofAlberta(the“AHSCISInformationSharingApproach”).



ThecontentoftheAHSCISInformationSharingApproachisexpressedthroughformaldocumentswhichincludethefollowing(referredtoasthe“InformationSharingToolkit”):

1) AHSCISinformationsharingobjectivesandprinciplesdescribedandassentedtoinaMemorandumofUnderstanding(“MOU”)specifictoaprofessionorusergroupwhichmayadditionallyspecifyconsiderationsorinformationstewardshipservicesuniquetothatgroup,

2) Elementstobeincludedintermsofreference(“ToR”)forAHSCISInformationStewardshipCommittees(“ISC”),

3) SupportmaterialsforthedevelopmentofanAHSCISInformationSharingCompact(“Compact”)summarizinginformationsharingrights,responsibilitiesandaccountabilitiesassentedbyAHSandCISusers,and

4) Considerations(test)fordeterminingwhetheranInformationManagementAgreement(“IMA”)isrequiredforindependentcustodiansandanIMAtemplateshowingrequiredIMAelements.

Scope

AHSVirtualFacility

TheAHSCISInformationSharingApproachappliestouseofAHSCISs,includingtheAHSProvincialCIS,intheAHS-wide“virtualfacility”(“Facility”).Afundamentalpremiseofthisapproachisthatthecreationandmaintenanceofhealthrecordsisnotdelineatedbyauser’saccesswithinaphysicallocation,suchasahospitalorAHS-operatedclinic.Instead,thescopeoftheAHSCISInformationSharingApproachisdefinedbytheinformationalfunctionsandservicescontainedwitheachtheAHSCISs,whichcanbeaccessedandusedbyauthorizedindividualsregardlessoftheindividual’slocation,facility,settingoraccessmethod.

ThegoaloftheProgram,asdefinedforthepurposesofanAHSProvincialCISInformationSharingApproach,istofosteranappropriateinformationsharingenvironmentwithintheFacility.Accessiscontingentuponsecureauthenticationandauthorizationtooneormore“roles”.TheintersectionofroleandallowedCIS“department”(sectionorgroup)determineswhatfunctions,informationandcapabilitiesaremadeavailabletotheuser.

SuccessfulaccessopensavirtualworkstationintheFacilityandthisiswhereCISinformationsharingoccurs.This“virtualmachine”doesnotexistontheuser’scomputerhardwareornetwork;instead,theuserhasawindowtotheFacility,withitsAHSnetworks,infrastructureandinfostructureenablingCISfunctionality.

AHSCISs

ExistingandanticipatedAHSCISsareallwithinthescopeoftheAHSCISInformationSharingApproach,includingtheanticipatedAHSProvincialCIS.



AlthoughAHSCISsmayexchangeinformationwiththeprovincialElectronicHealthRecord(Netcare),aswellasanynon-AHSoperatedPhysicianofficeEMRs(communityEMRs),thoseexternalsystemsarespecificallyoutsidethescopeoftheAHSCISInformationSharingApproach.

AHSCISUses

TheAHSCISInformationSharingApproachappliestothecollection,use,accessanddisclosureofHealthInformationtocareforpersons,populationsortheimprovementofthehealthcaresystem.Thisincludesusesfortraining,administration,processimprovement,outcomestracking,researchandotherformsofinstruction,inquiryandinvestigationaspermittedbytheHIA.

AHSCISUsers

TheAHSCISInformationSharingApproachappliestothoseindividualswhoauthenticatewithAHS-provisionedcredentialstogainaccesstotheFacility,irrespectiveofwheretheindividualhappenstobeorhowheorshegainsaccess;asprescribedbyAHS’securitypoliciesandprocedures.

Objectives

AHSCISInformationSharingApproachstakeholdersdesireinformationsharingwithinAHSCISstobebasedonthefollowingobjectives:

1. Principles-baseda. UsingplainlanguagetoexpresskeyHealthInformationsharingprinciples,consistent

acrosstheMOU,ToR,CompactandIMA.2. Patientandfamily-centric

a. Recognizingthatthepatient,asthe“owner”ofpersonalHealthInformation,isthefocusofpatient-centeredcareandallotherstakeholdersarethestewardsofthatinformationwithappropriateaccessandaccountabilities.

3. Improvement-orienteda. Promotingtimely,safe,andhigh-qualitycareofindividualsandpopulations,while

contributingtotheimprovementofthehealthcaresystemasawhole.b. Enablingdiseaseregistries,chronicdiseasemanagement,populationhealthandother

informationalmeanstohealthcareimprovementforpersons,populationsandsystems.c. Promotingcontinuingqualityimprovementandassurance,patientsafety,clinical

inquiryandhealthcareresearch.d. Linkingwithotherdatarepositoriestoimproveunderstandingofthedeterminantsof

healthinAlberta.e. Supportingthetrainingandeducationoffuturehealthcareproviders,thecontinuing

developmentofestablishedpractitioners,andtheabilityofthehealthcaresystemasawholetolearnandimprove.



4. Complianta. Upholdinginformationalbestpracticesconsistentwithapplicablelegislation(e.g.,HIA),

healthprofessionregulatoryrequirements(e.g.,healthrecordstandards),organizationalpolicies(e.g.,medicalstaffbylaws),andethicalnorms.

5. Collaborativea. EmphasizingmeaningfulCISend-userinvolvementininformationsharingoversight,

stewardshipandleadership.b. PromotingtrustamongallCISstakeholders,whilemotivatingparticipationinahigh-

performinghealthinformationecosystem.6. Pragmatic

a. Promotingequitabledataaccess,inquirysupportandqualityimprovement,withinthecapabilitiesofCIStechnologiesandoperationalcapacities,acrossAlberta’szonesandstakeholdergroups.

b. HarmonizingCISinformationstewardship,oversight,governanceandoperationsacrossallexistingAHSCISsandtheAHSProvincialCIS.

c. Optimizinguseoforganizationalresourcestoassuresafeandsustainabledatastewardship.

d. LeveragingexistingandemergingCISoperationalsupports(e.g.,ClinicalInquirySupportUnits,HealthInformationManagementunits,Analytics),researchinformationmanagementandinter-organizationalcollaborations.

7. Applicablea. Setting-agnostic

§ ApplyingtoanyhealthcaresettingwhereanAHSCISmightbeused(e.g.,community,emergency,criticalcare,inpatient,outpatient,home,etc.)anywhereintheprovince.

b. System-agnostic§ RecognizingthatAHSCISswillinteroperatewithoneanother,withtheAlberta

ElectronicHealthRecord,andwithenterprisehealthinformationsystems.c. Provider-agnostic

§ IncludingallhealthcareproviderswhoareauthorizedtouseandcontributetoanAHSCIS,irrespectiveofrole,stageofeducation,locationorrelationshipwithAHS(e.g.,employee,contractor,affiliate,medicalstaff,trainee).

8. Safea. Assuringsurveillance,auditing,andsafechannelsforreportingconcerns.



PrinciplesofInformationSharing

TheAHSCISInformationSharingApproachwillupholdthefollowingkeyprinciples:

1. Purposea. Informationissharedtopromotetheprovisionofintegrated,safe,high-quality,careto

personsandpopulations,whileenablingimprovementofthehealthcaresystemasawhole.

b. Theapproachwillrecognizethepatients’primaryinterestin,sharingof,andaccesstotheirHealthInformationforthefacilitationofintegratedcare,optimalhealthoutcomesandanexcellenthealthcareexperience.

c. Sharingofpatient,providerandorganizationalinformationismanagedinawaythatrespects,protectsandpromotestrustbetweenpatients,providersandtheorganization.

2. Rights,ResponsibilitiesandAccountabilitiesa. ExpressionsofCISinformationsharingrights,responsibilities,expectationsand

accountabilitiesaredevelopedcollaborativelywithstakeholdercommunities.3. Compliance

a. Informationstewardship,oversight,governanceandoperationswillcomplywithapplicablelegislation(HIA,HealthProfessionsAct,FOIP,etc.),organizationalpolicies,medicalstaffbylawsandprofessionalregulations.

b. AHSCISinformationsharingwillcomplywithAHSprivacy,confidentiality,securityandappropriateusepolicies.

4. Professionalisma. AHSCISinformationsharingpolicieswillalignwithapplicablehealthprofessions

standardsofpracticeandethicalnorms.5. Governance

a. AHSCISinformationstewardshipandoversightwillprovideformeaningfulhealthprofessionalrepresentationandparticipation.

6. Justicea. AHSCISuserswillaccessinformationinaccordancewithAHSpoliciesandprocedures,

developedinalignmentwiththerequirementsoftheHIAandotherapplicablelegislationandprofessionalregulation,withinputfromstakeholdersandoversightbyCISISCs.

b. ClinicianswhouseAHSCISsasthelegalrecordoftheirprovisionofhealthcareserviceswillbeabletoaccesstherecord,asneeded,foranyactivityrelatedtothemonitoringorassessmentofthequalityoroutcomesofsuchservicesforthedurationoftheirAHSaffiliation,andforanyperiodfollowingdeparturefromAHSaffiliationrequiredbylegislationand/orprofessionalregulation.

c. Decisionsbasedonhealthanalyticsinformationthataffectclinicaluserswillbeevaluatedinatransparentandreportablefashionbythoseaffected.

7. Learninga. CISinformationsharingwillenabletrainingoffuturehealthcareproviders,maintenance



ofcompetenceofcurrentproviders,andsupportfortheenterprisetobecomealearninghealthcareorganization.

b. Learnersandhealtheducationorganizations(Universities,Colleges)willbesupportedtocomplywithhealthtrainingaccreditation,credentialingorevaluationrequirements.

8. Inquirya. Informationsharingpolicies,proceduresandsupportswillpromotepatientsafety,

qualityassurance,qualityimprovement,diseasemanagement,decisionsupportandothermeanstooptimizehealthcareservices.

b. HealthanalyticsbasedoninformationsharedinanAHSCISwillbeusedtosupportclinicians,regulatorybodiesandpolicy-makers;andwillbeavailabletoeachinformstheycanaccessanduse.

c. FacilitateuseofHealthInformationtosupportthegoalsofothergroups,suchastheUniversities,QualityCouncilsandPublicHealthforeducation,qualityimprovementandresearch.

d. AHSCISinformationsharingwillsupportdiscoveryandhealthcareimprovementthroughclinicalresearchandinnovation.

RolesandResponsibilities

Clinicians,includingbutnotlimitedtoPhysicians,willbeusingAHSCISstocollect,use,accessanddiscloseHealthInformationinordertodeliverhealthcareservicesacrossthecontinuumofcare.AHSwillworkwithrepresentativesfromthevarioushealthprofessionalbodiestoalignCISprocesseswiththelegalandregulatoryrequirementsapplicabletothesegroups;toclarifytheirrespectiverolesandresponsibilitiesregardinginformationsharingrights,expectationsandaccountabilities;andtocollaboratewiththeserepresentativestoadapttheseprinciplesofinformationsharing.

TheAHSCISInformationSharingApproachwillrecognizekeystakeholderrolesandresponsibilities,including:

1. AlbertaHealthServices:AHS,asaRegionalHealthAuthority,playsacriticalroleinprovidingcontinuumofcarehealthservicesforAlbertansandismandatedtoprovideHealthServicesinamannerthatdeliversqualityhealthcareintheprovinceofAlbertaonasustainablebasisforthisgenerationandforgenerationstocomewithinAHSCISs.AsthestakeholderresponsibleforoperationoftheAHSCISs,AHSalsohasobligationstotakereasonablemeasuresforthesustainabilityandviabilityofthesystem,aswellasitsoperation.Inadditiontomeetingthesecomplianceandsystemobligations,AHSplaysaroleinencouraginghealthpractitionersandothersinAlbertatoworkcollaborativelytofacilitateappropriateinformationsharingforthebenefitofallAlbertans.

2. AlbertaHealth:WithrespecttotheAHSCISInformationSharingApproach,AlbertaHealthplaysamediatoryandadvisoryroletosupportthesuccessofthealloftheAHSCISsfortheoverallbettermentofhealthcareservicesinAlberta.AlbertaHealthiscommittedtoencourageuseofAHSCISsbythe



variousinterestedhealthcarerelatedpartiesincludingthepublic.3. RegulatoryBodies:

Theregulatedhealthprofessionsaremandatedbylegislationtobeoverseenbyregulatorybodies(e.g.,CollegeofPhysiciansandSurgeonsofAlberta)responsibleforassessingcontinuingcompetence,professionalconductandthosecredentialsnecessaryforpractice,andsettingstandardsthatmustbemetforacceptablehealthcarepractice.Somestandardsrelatetotheuseofdigitalhealthrecords,expectationsforclinicaldocumentation,andrequirementsforIMAs.TheAHSCISInformationSharingApproach,informationstewardshipprovisionsandIMAprovisionsrelyonmeaningfulengagementofthesebodiesandparticipationinongoingimprovements.

4. OversightgroupsPatientadvocates(e.g.,Patient&FamilyAdvisoryCouncil),ombudspersons(e.g.,AlbertaSeniorsAdvocate)andlegislatedoversightgroups(e.g.OfficeoftheInformationandPrivacyCommissioner)areanimportantresourceconsultedforadvice,reviewandpromotionoftheAHSCISInformationSharingApproach,objectivesandprinciples.

5. HealthProfessionAssociations:Thehealthprofessionshavewell-establishedassociations(e.g.,AlbertaMedicalAssociation)thathelporganizerepresentation,advocacyandaccountabilityfortheirmembers.TheAHSCISInformationSharingApproachacknowledgesthekeyroletheseplayinunderstandingandcommunicatingtheneedsofstakeholders;andcommitstoworkingwithprofessionalassociationstopromoteinformationsharingfoundedonmutualtrustandrespectforthebenefitofallAlbertans.

6. HealthEducationandResearchInstitutions:AHSCISusersparticipateinAHSCISsinwaysreflectingdifferentroles,purposesandcareerstages.Inparticular,AHSCISrelationshipsmaybeshapedbyparticipants’statusastrainees(e.g.,student,clerk,resident,fellow,re-certification),healthcareevaluators(e.g.,clinicalimprovementactivities),orfacilitatorsofhealthcareinquiry(e.g.,clinicalresearch).Alberta’shealtheducationandhealthresearchinstitutions,includingUniversitiesandCollegeswithhealthprofessionaltrainingprograms,arekeystakeholdersinAHSCISinitiatives,withsharedaccountabilitiesforhealthinvestigation,instruction,innovationandservice.

7. Clinicians:FortheAHSCISstosupportthepurposesoutlinedinthisdocument,itiscriticalpersonswhoprovidehealthcaregoodsorservicesdirectlytopatientsinAlbertaparticipateandbecomeengagedinthesuccessoftheAHSCISs.Clinicianswillberequiredtocollect,useanddiscloseHealthInformationwithinAHSCISsinordertodeliverHealthServices,mostoftenasaffiliatesofAHS.TheAHSCISswillbegovernedandoperatedinamannerthatisconsistentwiththecomplianceobligationsassetoutintheHIAbutalsothatareconsistentwiththeprofessional,education,qualityassurance,practiceaudit,accreditationandotherobligationsthateachClinicianisrequiredtoaddress.

AcknowledgementoftheAHSCISInformationSharingApproach,anditsformalagreementinstruments,maybeindicateddifferentlybydifferentgroups.



AHSCISInformationSharingCompact

Acompactisclearstatementofreciprocalexpectationsandaccountabilitiesbetweentwoormoregroups.Itisnotalegalcontractbutisamatterofpublicaccountability.Compactsarethedynamicoutcomeofcollaborativeeffortstounderstandsharedinterests.Theyleveragecommongoals–suchasimprovingcareforpatientsandpopulations–todiscoverhowparticipantinterestscanbebestaligned.

TheAHSCISInformationSharingCompactwillfacilitatedeclarationofkeyprinciples,rightsandresponsibilities;highlightingAHSandtheapplicableCISusergroup’saccountabilities.Itwillbereferencedinallaccessagreements,AHSpoliciesandstaffbylawsandwillbeintegratedwithhealthprofessionaltrainingandPhysicianon-boardingprotocols.

TheCompactwillbevalidatedwithvariousstakeholdergroups,startingwithPhysicians.TheCompactwilladdressthefollowingconsiderationsforanAHSCIStoimprovehealthcare:

• Emphasisonresponsible,professional,accountableandsafeinformationsharingintheserviceofeffectiveandefficientcareforbothpatientsandpopulations.

• ResponsibilityofallCISstakeholderstoupholdinformationalbestpractices,consistentwiththeHIA,professionalregulatorystandardsofpractice,andhealthprofessionalethicalstandards.

• Acknowledgementoftheuniquelimitationsandimplicationsofsharedenterpriserecordsthatcrossthecontinuumofcareandintegrateorganizationalinformationassets.

• RecognitionofthepatientasownerofHealthInformationandthecollectiveresponsibilityofthehealthcareteamtostewardandprotectthatinformation.

• EmbraceallhealthcareproviderswhocontributetotheCIS,irrespectiveofrole,leveloftraining,locationorrelationship(e.g.,employee,contractor,affiliate,trainee).

• ReferenceandalignwiththeAHSCISInformationSharingApproachprinciples.• ReferenceHealthInformationsystemprivacyawarenessandtrainingcommitments.• ReferencerelevantAHSbylaws,policiesandprocedures.• Referencechartingnorms,minimumuseexpectationsandguidestosafeparticipationinCIS

communities.• Promoteuserengagementwith,andparticipationin,informationstewardshipactivities.• AdvocateinformationsharingbehaviorsthatminimizeinformationburdensacrossallCISusers.

AninitialdraftCompactwillbedevelopedwithAHSassistanceincollaborationwithPhysicianstakeholders.TheCompactmaybeadjusted,usingthesupportmaterialsreferencedunderthesubheading“Approach”atthebeginningofthisStatementofPrinciples,withreviewbyHIDGC,afterconsiderationbyotherhealthcareprovidergroups.

AcknowledgementoftheCompactwillbeincorporatedintoaccessandtrainingprocessesforallusers.Anyonegaining,orreactivating,aCISuseraccountwillacknowledgetheCompact.



InformationManagementAgreement

InthosesituationswhereAHSCISusersqualifyasindependent“custodians”,pursuanttotheHIA,forthepurposesoftheirparticularuseandaccesstoanAHSCIS,theAHSandapartywhomeetsthecriteriaintheIMATest(“RequirementforanInformationManagementAgreement”intheInformationSharingToolkit)willberequiredtoenterintoanIMAwithAHSthatcomplieswiththerequirementsoftheHIAandregulations.

AnAHSCISInformationSharingIMATemplate(“InformationManagementAgreement”intheInformationSharingToolkit)hasbeendevelopedtooutlinethecontentexpectedinanAHSCISIMA.Specificindependentinstancesmaymeritadditionsorclarificationstothetemplate.

DataStewardshipServices

DataStewardshipConsolidation

PriortothedevelopmentandadoptionofthisStatementofPrinciples,AHSconductedanextensivereviewofthepolicies,proceduresandlinesofserviceapplicabletotheformerISFconstruct.ThisreviewidentifiedinformationmanagementbestpracticesthatcanbeappliedtotheexpandedAHSCISs,includingtheAHSProvincialCIS.

Thereviewalsomoreclearlydistinguished“datastewardship”asanoperationalmatter,from“informationstewardship”asamatterforgovernance.ManyredundancieswereidentifiedinthedeliveryofdatastewardshipservicesacrossAHSCISsandmanyinconsistencieswereidentifiedamongdatastewardshippractices.The37datastewardshiplinesofservicedescribedintheISFdidnotlineupconsistentlywithaccountableoperationalcapacityinAHS.Accordingly,aplanwasdevisedforcoordinatingdeliveryofdatastewardshipservicesinamannerthatisbalanced,fiscallyresponsible,andsustainablebyleveragingexistingAHSprocessesandprocedures.Theseservicesweregroupedintocategoriesbasedonsynergiesthatallowforflexibledeliveryandalignmentwithoperationalresponsibilities.

DataStewardshipServices

AHSincollaborationwiththeAMAandotherkeyinternalandexternalstakeholdershasgroupeddatastewardshipservicesintothefollowinghighlevelgeneralcategories:

Privacy PrivacyservicesrelatetoimplementationofpoliciesandproceduresconsistentwiththeprivacyandconfidentialityrequirementsoftheHIA,otherapplicablelegislation,AHSpoliciesandproceduresandhealthprofessionregulatorystandards.Thisincludesprovisionsforprivacyeducationandtraining,compliancemonitoringandprocessesforidentifying,managingandreportingonanyviolationorbreachofHealth



Informationprivacy.

Security Informationsecurityservicesincludeprocessestoprevent,manageandreportanybreachofCISsecurity(includingsecuresystemaccess,encryptionofdatatransmission,andprotectionofstoredinformation)oranyweaknessormalfunctionoftheinfrastructureorinfostructuresupportingaCISthatmight,inturn,poseasecuritythreattotheCIS.

Infrastructure Informationtechnologyinfrastructureservicesrelatetothecomputers,networksandsupportsystemsthatensuretimelyaccesstoandreliablefunctionofaCIS.Thisincludesdatabaseoperations,servers,networks,wirelessservices,end-userdevices,andremoteaccesstechnologies;allofwhichhaveprovisionfordown-timeandbusinesscontinuityintheeventoftechnologyfailures.

Records CISdataandrecordsmanagementservicesrelatetotheorganization,storage,retrieval,copy,export,archivinganddispositionofdigitalpatientrecordswithintheCIS.TheseservicesarecoordinatedtoensurethatCISHealthInformationisaccessibleinwaysthatsupporttheCISmandatewhilecomplyingwithlegislative,regulatoryandorganizationalrequirements.

Applications InformationtechnologyapplicationservicesrelatetotheoperationalmaintenanceoftheCISsoftwareandanyconfiguration,customizationoradaptationsthatusersdependupon.Thisincludesmaintenance,upgrade,enhancementandCIS-to-CIStransitionservices.

AccessSupport

CISaccessservicesrelatetotheapproval,set-up,monitoring,andmaintenanceofalluseraccounts;includingassignmenttodepartments,rolesandsecurityprofiles.Theservicealsocoversliaisonwithpartnerandstakeholderorganizations(e.g.healtheducation)tofacilitatesmoothon-boardingofnewusersanddeactivationofexpiredorinappropriateaccess.Accesssupportservicesalsoassureapplicationofprivacyawarenesstraining,onboardinghelpandrequirementcompliance.

Standards CISinformationsharingpolicy,procedureandstandardsdevelopmentservicesworkcloselywithCISISCstoensurethatinformationsharinganddatastewardshippolicies,standardsandguidelinedevelopmentisdeliberate,transparentandeffective.Decision-makersareprovidedwithinformationneededtoguidepolicydevelopmentandperiodicrevision.End-usersarealertedtopolicyandprocedureimplicationsthroughappropriatecommunicationchannelsandchangemanagementprocesses.

Training CISusersupportandtrainingservicesincludeanyCISusetraining,skillsdevelopment,capacitybuildingorotherinterventionsneededtoassureCIS



Support userawarenessofkeypolicies,engagementwithpolicygoals,andenablementformeaningfulcompliance.

Exchange CISinformationandtechnologyexchangeservicesrelatetohowhealthdataandinformationissharedbetweensourceordestinationhealthinformationsystems,howitisdistributedandretrievedfromarchivalsystems,andhowitismigratedfromoneCIStoanotherastheAHSProvincialCIStakesholdprovince-wide.

ThesedatastewardshipcategoriesareusedtocoordinatedeliveryofdatastewardshipservicesonasustainablebasisacrossallAHSCISs(includingtheAHSProvincialCIS).WorkineachcategorywillbecoordinatedbyAHSforeachoftheAHSCISsinaccordancewithprocessesandproceduresdevelopedbyAHSandotherkeystakeholders,includingguidanceandpoliciesdevelopedbytheapplicableISC.Mostimportantly,thedatastewardshipservicecategoriesaremappedto,andwilloptimallyuse,AHSexistingoperationalandtechnicalinfrastructure.Thegoalistomakeeffectiveuseofexistingcapacitieswhilestrivingtoavoidunnecessaryduplicationofeffort.

Datastewardshipcategoriesanddescriptionsaremeanttobeflexibletoallowforchangesovertime.Technologieswillevolve,applicablelegislationorregulationmaychange,andorganizationalcapacitiesmaybereorganized.ItisalsoimportanttonotethatnotalloftheseservicecategorieswillapplytoallAHSCISsequally;givendifferencesinCISsoftware,datamanagementtechnologiesandcapabilities.

DataStewardshipOperations

AllAHSCISInformationSharingApproachoperationalsupportswillbeintegratedwithexistingAHShealthinformationmanagementcapacity,informationtechnologycapability,researchandinnovationcapacity,informationandprivacycapacity,andChiefMedicalInformationOfficecapacity;withtheseconsiderations:

• InfulfillmentofitsHealthInformationcustodialresponsibilities,AHSoverseesoperationalsupportforallAHSCISinformationstewardshipactivities.

• OperationalsupportsprovidedbyAHSforCISinformationsharing,monitoringanddatastewardship,willbemanagedandcoordinatedbyAHS.

• Coordinationofthereleaseofinformation,misusemonitoring,breachreportingandotherdatastewardshipactivitiesfollowsthesameprocessesforallAHSCISs,consolidatedwithexistingAHSsupportstomaximizeefficiency,consistencyandaccountability.

• CompactdevelopmentwillbesupportedbytheAHSChiefMedicalInformationOfficeandAHSMedicalAffairs.



Governance

InformationStewardship

“Informationstewardship”relatestooversightofthemanagementofHealthInformation,includingthecollection,use,disclosure,managementandsecurityofthatinformation.Informationstewardshipspeakstothe“what”ofgovernance.ItreflectsthetenetthatHealthInformationis“owned”bythepatientwhothensharesinformationwithhealthcareserviceprovidersaspartofatrustedrelationship.Careprovidersandorganizationsthenbecomestewardsoftheinformation,withadutytouseanddisclosetheinformationresponsiblyandtotakereasonablestepstoprotectit.

InformationStewardshipCommittees

Historically,decisionsaboutprovidingaccesstoinformationcouldbemadebyacareteamonacasebycasebasis.AstheuseofCISshasexpanded,informationstewardshipdecisionsareincreasinglymadebyarepresentativegroupofhealthprofessionalsandusers;herecalledanISC.

ISCsplayanimportantroleinensuringthatthoseimplementingandusingAHSCISsareabletomeetthelegal,regulatoryandethicalobligationsplaceduponthem.TheyprovideamechanismtoensurethatdecisionsrelatedtothemanagementanduseofinformationcontainedinaCISconsidertheinputandinterestsofcareprovidersandpatients;andameansofachievingtransparencyanddemonstratingaccountabilityfortheuse,disclosureandprotectionofinformation.

AHSCISinformationstewardship,informationsharingoversightandoverallgovernancewillbesupportedbyAHSorganizationalstructures,committees,workgroupsandaccountabilities.Additionally,provisionwillbemadeforindependentproblem-reportingordisputeresolutionwhereissuesarenotsatisfactorilydealtwithbyAHSCISISCsorothergovernancestructures.

AtemplateforISCTermsofReferenceisdevelopedtosupporttheAHSCISInformationSharingApproach,withthefollowingkeyprovisions:

o EachAHSCISwillbeassociatedwithanISCresponsibleforthereviewofinformationsharingpoliciesandstakeholderarrangementsrelatedtotheaccess,use,anddisclosureofCISinformation.

o ISCswilloverseecompliancewithlegislativeandregulatoryrequirementsandwillprovideforperiodicreviewofdatasharingsurveillanceanddatauseauditsforpotentialmisuse.

o ISCtermsofreferencewillassuremeaningfulinputfromthehealthprofessions,includingPhysicians.

o InformationstewardshippolicieswillharmonizewithanypoliciesandproceduresdevelopedbytheAlbertaHIDGCforprovincialapplicability.

o AHSCISinformationsharinggovernancewillalignwiththeAlbertaprovincialhealthinformationgovernanceframework,overseenbytheHIDGC.

o EachoftheAHSCISISCswillreporttoAHSCISoversightcommitteesandtheAHSProvincialCISISCwillreporttotheAHSProvincialCISStandardsandContentCommittee.



o AHSCISISCchairswillreportkeydevelopmentstoHIDGCatleastquarterly.

Representation

TheAlbertaMedicalAssociation,CollegeofPhysiciansandSurgeonsofAlbertaandtheFacultiesofMedicinewillbeprovidedwithexplicitrepresentationonAHSCISISCs.

Accountability

AHSCISISCswillbeaccountabletoAHSexecutiveandrelevantCISgovernancecommittees.EachAHSzonewillhaveanISCspecifictoitsexistingCIS(Meditech,SunriseClinicalManager,eCLINICIAN).TheAHSProvincialCISwillalsohaveanISC.AstheAHSProvincialCISgrows,andexistingCISsareretired,theAHSProvincialCISISCwillreplaceexistingCISISCs.

ExistingCISISCswillreporttothesenioroversightandgovernancecommitteefortheCIS(eCLINICIANAmbulatoryOversightCommitteeintheEdmontonZone;SCMCoreClinicalDesignTeamCommitteefortheCalgaryZone;MeditechSteeringCommitteeforNorth,CentralandSouthZones).TheAHSProvincialCISISCwillreporttotheAHSProvincialCISStandardsandContentCommittee.

ExistingCISISCswillliaisewiththeAHSProvincialCISISCandwilladoptorharmonizedwithprovincialpoliciesexceptwherethesecannotbeimplementedbytheCIS.TheAHSProvincialCISISCwilladditionallybeaccountableforharmonizationwithHIDGCpoliciesandprovincialinformationsharingframeworks.

DisputeResolution

IssuesthatcannotberesolvedbyISCs,orreportsofsignificantconcernsthatcouldaffectdatasharingprovincially,canbereferredtodisputeresolutionpathwayswiththefollowingkeyprovisions:

• AHwillprovideanavenueofdisputeresolutionshouldAHSCISstakeholdersfailtofindclosurethroughAHSISCandCISgovernancecommitteeissueresolutionprocesses.

• Thealternatedisputeresolutionpathwaywillbeavailabletohealthcareprofessionalswhohaveexhaustedallwithin-AHSoversight,deliberationandinformationstewardshipresourcesforresolvingasignificantinformationsharingissue.

• TheAlbertaHealthExecutiveDirector,InformationManagementBranch,willactasthecontactforanydisputeinquiriesorescalationrequests.

• Shouldadisputenotberesolvedbymeansavailabletotheexecutivedirector,theHIDGCwillbethenextpointofescalationfollowedbytheHealthMinister(ifrequired),withdecisionsthatarebinding.

• Thesedisputeresolutionpathwaysdonotimplylackofaccesstootheravenuesforinvestigation,suchasthoseprovidedbytheOIPC,theCPSAorotherhealthinformationadvocates.



Transitions

TheAHSCISInformationSharingApproachandInformationSharingToolkitwillcompletelyreplaceallpriorinstruments,agreementsandarrangementsrespectingoversightofAHSCISs.TheAHSCISInformationSharingApproachandInformationSharingToolkitmayberevisitedandrevised,fromtimetotime,subjecttoreviewbytheHIDGC.Intheeventthatothersareassigneddutiesassociatedwithrelatedagreements,theprinciplesandobligationscontinuetoapply,subjecttoreviewbytheHIDGC.

Greatcarewillbetakenbythekeystakeholderstocommunicateeffectively,provideforchangemanagementandsafelytransitionoversightandoperationstothegroupsandcapacitiescontemplatedbytheAHSCISInformationSharingApproach.



Definitions

ForthepurposesoftheCISInformationSharingApproach,MOU,andToolkit(AHSCISInformationSharingApproachPrinciples,AHSCISInformationSharingCompact,AHSInformationStewardshipCommitteeTermsofReferenceTemplate,AHSCISInformationManagementAgreementTemplate),thefollowingtermsshallhavethemeaningsassignedtothembelow:

“AH”meansHerMajestytheQueeninrightofAlberta,asrepresentedbytheMinisterofHealth;

“AHS”meansAlbertaHealthServices,acorporationestablishedasaregionalhealthauthoritybytheMinisterofHealthpursuanttos.2(1)oftheRegionalHealthAuthoritiesAct,RSA2000,c.R-10;

“AHSCISs”means,asthecontextrequires,anyoneorallofeCLINICIAN,Meditech,SunriseClinicalManagerandtheAHSProvincialCIS;

“AHSInformationSharingApproach”meanstheinformationsharingphilosophyapplicabletothecollection,access,useanddisclosureofHealthInformationwithinanAHSCISassetoutintheStatementofPrinciples;

“AHSProvincialCIS”meansasingleone-person-one-record-one-systemCISoperatedbyAHSthroughouttheProvinceofAlberta;

“AMA”meanstheAlbertaMedicalAssociation(CMAAlbertaDivision),representingitsmembersforthepurposesoutlinedintheMOU;

“Affiliate”hasthemeaningassignedtothistermintheHIA;

“Attachments”meanstheschedulesincorporatedbyreferenceintotheMOU;

“ClinicalInformationSystem”or“CIS”meansanintegratedinformationmanagementplatformsupportingthecollection,access,useandsharingofinformationsupportingthedeliveryofhealthcareservicestopersonsandpopulationsinmultiplesettingsacrossthecontinuumofcare;

“Clinician”meansanypersonwhoprovideshealthcaregoodsorservicesdirectlytopatients,asopposedtobeingengagedinhealthcareforotherpurposes,suchasresearchoradministration;

“CPSA”meanstheCollegeofPhysicians&SurgeonsofAlberta,asconstitutedpursuanttotheHealthProfessionsAct,RSA2000c.h-7,oritssuccessorlegislation;

“Compact”meansaCISInformationSharingCompactwhichisclearstatementofreciprocalexpectationsandaccountabilitiesbetweentwogroups;applicabletoallwhocollect,access,useanddiscloseHealthInformationwithinanyAHSCIS;

“CovenantHealth”or“Covenant”meansthatcorporationincorporatedpursuanttotheCovenantHealthAct,S.A.1992,c.R-39,asamended,topursuetheobjectsdescribedinthatAct.



“Custodian”hasthemeaningassignedtothistermintheHIA;

“eCLINICIAN”anambulatoryCISmanagedbyAHSintheEdmontonZonethatsupportsreferralmanagement,patientscheduling,electroniccharting,secureprovidermessagingandPhysicianbilling;

“EffectiveDate”hasthemeaningascribedtosuchtermonthefaceoftheMOU;

“EMR”or“ElectronicMedicalRecord”meansarecordofhealthcareservicesandrelatedinformationmaintainedbyhealthcareprovidersinanelectronicsystemforaccessandusebyhealthcareproviders;

“Facility”hasthemeaningascribedtosuchtermunderScope;

“FacultiesofMedicine”referstotheUniversityofAlbertaFacultyofMedicine&DentistryandtheUniversityofCalgaryCummingSchoolofMedicine;

“HIA”meanstheHealthInformationAct,RSA2000,c.H-5,andamendmentsthereto,aswellasregulationspassedthereunder;

“HIDGC”meanstheHealthInformationDataGovernanceCommitteeestablishedpursuanttoMinisterialOrderM.O.308/2016datedJune29,2016;

“HealthInformation”hasthemeaningascribedtothattermintheHIA;

“HealthProfessionalBody”hasthemeaningascribedtothattermintheHIA;

“HealthService”hasthemeaningascribedtothattermintheHIAand“HealthcareService”hasthesamemeaning;

“HealthcareEducationOrganizations”includesallUniversities,CollegesandInstitutesinAlbertaprovidingdegree,diplomaorcertificatetrainingrelatedtohealthcareprofessions;

“ISC”meansanInformationStewardshipCommittee;

“InformationManagementAgreement”or“IMA”referstoanagreementbetweenAHS,asanInformationManager,andnon-AHS-affiliatedcustodian(s)ofHealthInformationsharedinanAHSCIS,enteredintopursuanttosection66oftheHIA;

“InformationSharingFramework”or“ISF”meanstheconceptofgoverningthedisclosureanduseofinformationinanelectronicmedicalrecordestablishedpursuanttoaMemorandumofUnderstandingexecutedbetweenAHS,theAMAandCovenantHealthdatedApril1,2012,asamendedfromtimetotime;

“InformationSharingToolkit”meansthebodyofdocumentsdevelopedbythekeystakeholderstogivemeaningtotheAHSCISInformationSharingApproach;

“InformationStewardshipCommittee”meansthatcommitteedescribedintheInformationSharingApproachandhavingtheresponsibilitiesanddutiesdescribedtherein;



“ISF”meansInformationSharingFramework;

“Meditech”ahealthinstitutionCISmanagedbyAHSinitsruralzonesthatsupportstheprovisionofhealthcareservicesinthosezones;

“MemorandumofUnderstanding”or“MOU”meanstheMemorandumofUnderstandingagreemententeredintobetweenAHSandoneormorestakeholders,referencingotherelementsoftheInformationSharingToolkit,thatrecordsanyconsiderationsspecifictoaparticularhealthprofessionorstakeholderorstakeholders;

“Physician”meansamedicaldoctordulylicensedtopracticemedicineintheProvinceofAlbertabytheCPSA;

“Program”meanstheAHSProvincialClinicalInformationSystemProgramestablishedbyAHandAHStoimplementandrolloutthevariouspartsoftheAHSProvincialCIS;

“RHAA”meanstheRegionalHealthAuthoritiesAct,RSA2000c.R-10;

“Staff”meansanyemployee,contractor,consultant,memberofmedicalormidwiferystaff,volunteer,studentandotherpersonsactingonbehalfofAHS;

“SunriseClinicalManager(SCM)”isaCISmanagedbyAHSintheCalgaryZonethatsupportstheprovisionofhealthcareservicesinthatzone;

“ToR”or“TermsofReference”meanstheapplicableTermsofReferenceforanyISCprovidingoversightforinformationsharingpolicyandgovernancerelatedtoanAHSCISortheAHSProvincialCIS.

Schedule “B” – Information Sharing Compact Draft

AHSClinicalInformationSystemInformationSharingApproach InformationSharingCompact


DRAFT

AHSClinicalInformationSystemInformationSharingCompact

supportingan

ApproachtoInformationSharing

amongusersof


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Context

Information Sharing

For an Alberta Health Services (AHS) Clinical Information System (CIS) initiative to achieve its goals, it is essential that the right information be appropriately captured, documented, shared, disclosed and used. These are matters of information sharing. They touch the core of health care professionalism and change as clinicians move from siloed paper records to shared digital records.

In order to address the need for CIS information sharing norms, and to account for professional obligations and legislative imperatives, a CIS Information Sharing Compact is developed by AHS in collaboration with healthcare professionals. Its adoption can promote effective information sharing in continuum-of-care enterprise clinical information systems.

Compacts

A compact is clear statement of reciprocal expectations and accountabilities between two groups. It is not a legal contract but is a matter of public accountability. Compacts are the dynamic outcome of collaborative efforts to understand shared interests. They leverage common goals – such as improving care for patients and populations – to discover how participant interests can be best aligned.

Drafting Workshop

This draft AHS CIS Information Sharing Compact derives from a compact-development workshop (June 21, 2917 and follow-up review) attended by ten physicians with experience in a wide range of clinical contexts, practice types and parts of Alberta. The workshop was facilitated by Mr. Sean Garrett, who has Compact development expertise and was appointed to this role by the ISF Working Group.

This draft may be further revised by this group and then will serve as the starting point for Compact validation sessions with a wider range of health care professions.

Workshop Participants

Although ISF Working Group members were invited to recommend workshop participants with the desired breadth of front-line experience, the final attendee list was derived to maximize diversity of geography, experience and years in practice. With a goal of approximately 10 workshop attendees, the following physicians prepared for and attended the June 21 session:

• Dr.TimGraham(emergencymedicine,urban,north,community)• Dr.TomRich(emergencymedicine,urban,south,facility)• Dr.MarkForder(familymedicine,rural,north,community)• Dr.SethHeckman(obstetricsandgynecology,ruralfirstnations,north,community)• Dr.VanessaMaclean(familymedicine,rural,south,community)• Dr.RyanSnelgrove(surgery,urban,north,facility)• Dr.BrendanBunting(familymedicine,rural,central,community)• Dr.AllenAusford(familymedicine,urban,north,community)• Dr.JacquesRomney(internalmedicine,urban,north,community&facility)• Dr.StuartRosser(internalmedicine,urban,north,community&facility)• Dr.EchoEnns(hospitalist,urban,south,facility)• Dr.RobertHayward(internalmedicine,provincial,AHSCMIO)



DraftInformationSharingCompact

Principle AHSResponsibilities ClinicianResponsibilities

PatientGuided Prioritizeinformationsharingprocessestosupportpatientwellbeingfirst,easeofusenext,followedbyorganizationalneeds.

Embraceandsupportinformationsharingforpatientwellbeingandclinicalimprovement.

ProviderAccess

Facilitatetimely,reliableandsecureaccessforallCISuserswhereverandwheneverCISinformationsharingisrequired;includingenduringaccessforlegalorprofessionalrequirements.

CareforandmaintainsecureCISpersonalaccesscredentials,whilekeepingclinicalcontactinformationcurrentandaccurate.

PatientAccess FacilitatetimelyandsecureCIShealthrecordaccessforpatients,usingapatientportalwherepossible.

RespondtopatientqueriesaboutCIShealthrecordsanddirectasappropriatetoinformationservices.

Disclosure Receiveandcoordinaterequestsforthedisclosureofhealthinformation,tothirdparties,respectingtheinputofaffectedclinicians.

Respondpromptlywhenmadeawareoftheneedtodisclosehealthinformation,respectingpatients’expressedwishes.

ProtectionofInformation

Develop,implementandsupporttechnical,physicalandadministrativesafeguardstoprotecthealthinformationwhileenablingappropriateusertraining.

BeawareofandadheretoCISinformationprotectionsandnotifyAHSwhencompromiseorbreechissuspected.

Use Betransparentandaccountabletoclinicians,staff,governmentandthepublicwithrespecttouseofhealth,clinicianororganizationalinformationstoredinorextractedfromtheCIS.

BeaccountableforthealloweduseofCISpatient,provider,andpracticeinformationwhilerespectingthecontributionsofothers.

ClinicalandHealthSystemImprovement

Supportclinicalandhealthsystemimprovementinitiatives,includingclinicalresearch,qualityimprovementandeducationaladvancement.

Identifyopportunitiesforclinicalandhealthsystemimprovementandcollaboratetoproduceandusetheinformationrequired.



Principle AHSResponsibilities ClinicianResponsibilities

Accuracy TakestepstoensurethatdatafeedsflowingintoandoutoftheCISareaccurate,reliableandcorrected;andprovideuserswithconvenientmeanstoreportpossibleerrors.

Completely,accuratelyandpromptlycontributehealthcareserviceinformationtotheCIS,usingacceptedstandards;andreportpossibleerrors.

Governance Establishbalanced,multidisciplinaryandmeaningfulCISinformationsharinggovernancestructuresthatareempoweredtoaddressinformationsharingissues.

Availofopportunitiestomeaningfullyparticipateininformationsharinggovernancestructures,includingreportingpossibleissuesforreview.

Schedule “C” – Information Stewardship Committee Terms of Reference Template

AHSClinicalInformationSystemInformationSharingApproach InformationStewardshipCommitteeToRTemplate


InformationStewardshipCommitteeTermsofReferenceTemplate

supportingan

ApproachtoInformationSharing

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Overview

InformationStewardship“Informationstewardship”relatestooversightofthemanagementofhealthinformation,includingthecollection,access,use,disclosure,managementandsecurityofthatinformation.Informationstewardshipspeakstothe“what”ofgovernance.Informationstewardshipisbasedonthetenetthathealthinformationis“owned”bythepatient,whilethosepartiesprovidinghealthcareservicesbecomestewardsoftheinformation,withadutytouseanddisclosetheinformationresponsiblyandtotakereasonablestepstoprotectit.TheadventofClinicalInformationSystems(CISs)hassubtlychangedinformationstewardshipparadigmsinshareddigitalhealthrecords.ACISisanintegratedinformationmanagementplatformsupportingthecollection,access,useandsharingofinformationaboutthedeliveryofhealthservicestopersonsandpopulationsinmultiplesettingsacrossthecontinuumofcare.AlbertaHealthServices(AHS)hasexistingCISs(eCLINICIAN,SunriseClinicalManager,Meditech)operatinginitsZones(Edmonton,CalgaryandRuralrespectively)andanticipatesdeploymentofanAHSProvincialCISAlberta-wide;ultimatelytoreplaceallZoneCISs.Historically,decisionsaboutinformationsharingcouldbemadebyacareteamonacasebycasebasis.AstheuseofCISshasexpanded,informationstewardshipdecisionsareincreasinglymadebyarepresentativegroupofhealthprofessionals,usersandotherstakeholders;calledanInformationStewardshipCommittee(“ISC”).InformationStewardshipCommitteesISCsplayanimportantroleinimplementingandusingCISsinamannerthatisabletomeetthelegal,regulatoryandethicalobligationsofthoseusingandmanagingthetechnology.ISCsprovideamechanismtoprovidegovernanceandoversightoverthedevelopmentofpoliciesrelatedtothemanagementanduseofinformationcontainedinaCIS,consideringtheinputandinterestsofpatients,providersandthehealthcareenterprise.Wheneffectivelyimplemented,ISCsprovideameansofachievingtransparencyanddemonstratingaccountabilityforthecollection,access,use,disclosureandprotectionofhealthinformation.TermsofReferenceTemplateThefollowingtemplatecanbeusedtocreatetermsofreferenceforanAHSCISISC.EachoftheexistingAHSCISswillhaveitsownISCspecifictothatCIS.TheAHSProvincialCISwillalsohaveanISC.AstheAHSProvincialCISgrows,andtheotherCISsareretired,eventuallytheAHSProvincialCISISCwillreplacealltheotherAHSCISISCs.AccountabilityItisanticipatedthatISCsforeachoftheAHSCISswillreporttoasenioroversightandgovernancecommitteefortherespectiveCISasfollows:eCLINICIANAmbulatoryOversightCommitteeintheEdmontonZone;SCMCoreClinicalDesignTeamCommitteefortheCalgaryZone;MeditechSteeringCommitteeforNorth,CentralandSouthZones).TheAHSProvincialCISISCwillreporttotheAHSProvincialCISStandardsandContentCommittee.AllISCsliaisewiththeprovincialHealthInformation&DataGovernanceCommittee.Thisaccountabilitystructureispreliminaryandmaychange.



CISInformationStewardshipCommitteeTermsofReference

ClinicalInformationSystem:[Specify“eCLINICIAN”,“MEDITECH”,“SunriseClinicalManager”or“AHSProvincialCIS”(the“AHSCIS”)]

Co-Chairs:[InsertnamesofAlbertaHealthServices(AHS)co-chairshere.ItisrecommendedthatoneofthechairsbeaphysicianwithaformalCISphysicianleadershiproleandtheotheraCISleaderfromclinicaloperations;matchingthe“dyad”co-chairingofotherClinicalInformationSystem(CIS)governancecommittees.]

Purpose:

ThisAlbertaHealthServices(AHS)ClinicalInformationSystem(CIS)InformationStewardshipCommittee(ISC)isresponsibleforprovidinggovernanceoversight,directionandguidanceoverinformationsharingpoliciesandstakeholderarrangementsrelatedtothecollection,access,use,anddisclosureofhealthinformationintheAHSCIS.

Mandate:

ThisAHSCISISCisaninformationorientedcommitteeresponsibleformakingrecommendationstoandresolvinggovernancemattersrelatingtoinformationsharingpolicymattersfortheAHSCIS.Itmaybeaskedtorespondtoissuesraisedbyexecutivecommitteesitreportsto,bytheAlbertaprovincialHealthInformationDataGovernanceCommittee(HIDGC),orbyotherAHSCIScommitteesandworkgroups.

TheISCwillcontributetothesuccessfuldesign,deploymentandoperationofitsassociatedCISthroughproactiveidentificationandtimelyresolutionofinformationsharingissues.TheISCrecognizestheneedforstrongalignmentwithAHSexecutivegoalsandanyoverallprovincialinformationsharingstrategyoverseenbyHIDGC.

TheISCwillendeavorto:

• Provideguidanceoninformationprivacy,securityandstewardshippoliciesrelatingtoorarisingfromtheuseoftheapplicableCIS;

• ProvideguidanceontheinitialdevelopmentorperiodicreviewofpoliciesandstakeholderarrangementsrelatingtoCIShealthinformationaccess,useordisclosurepolicies;

• IdentifygapsinexistinginformationsharingpolicyandstandardsrelatedtoCISinformationsharing;

• AdviseonotherinformationstewardshipprinciplesorissuesrelatingtotheCISasraisedbyCISgovernancecommittees;

• EnsurethatzonalCISinformationstewardshippoliciesarealignedwithAHSProvincialCISinformationstewardshippolicies;



• EnsureCISpoliciesareharmonizedwithHIDGCpoliciesandanyprovincialinformationsharingframework;

• Considerhealthprofessionregulatorycomplianceobligationswhenestablishingdatastewardshippolicies;

• EscalateunresolveddisputesandareasofseriousconcerntoCISGovernanceCommittee(s)and/orHIDGC,asappropriate;and

• RecommendCISstandards,guidelinesandpoliciesregardingsystemconfiguration,defineduserrolesandpermissions,rulesformaskingand/orblockingofinformation,department-specificprotections,datastewardshipsurveillancereportsandreportingtools,datalifecyclemanagement,andotherCISapplication-specificinformationmanagementissues.

TheISCisnotresponsibleforimplementinginformationsharingpolicies.Onceanissuehasbeenidentifiedandaddressed,possiblythroughgenerationofpolicies,implementationishandedtoAHSoperationalgroup(s)responsibleforCISdatastewardshipservices.TheISCmayrequireperiodicreportingorotherfeedbackfromCISdatastewardshipservicesaboutISCpolicyimpactorcompliance.

Accountability

ThisAHSCISISCisaccountabletothe[insertrelevantzoneCISorprovincialCISseniorgovernanceoroversightcommittee].TheISCwillliaisewiththeAlbertaprovincialHIDGCandwillreportaboutsignificantnewpoliciesorissuesquarterly.

Membership

ISCmembershipmustbebroadinordertoallowformeaningfulrepresentationofclinicalareasandprofessionalperspectives.SpecificprovisionismadeforAlbertaMedicalAssociation,AlbertaCollegeofPhysiciansandSurgeonsandregionalUniversityrepresentation,withonevotingmembereach.TheremainderofthemembershiprepresentsAHSareasandaccountabilitiesimportanttoclinicalpracticeandinformationsharing.Somezonesmayhaveamajorpartnerhealthcareproviderpresence(e.g.,CovenantHealth)meritingrepresentation.

TheISCco-chairswillworkcloselywiththeSecretariattoensureappropriateinvitationsareextendedforeachmeeting,basedonpre-determinedagendatopics.Membershipwillbereviewedevery2years.

CommitteeVotingMembers(exampleonly;tobeadjustedtotheneedsofeachISC)

ISCRequiredVotingMembers Co-Chair,AssociateCMIO(ZoneCIS)orCMIO

(ProvincialCIS) Co-Chair,ClinicalOperationsDirector(ZoneCIS)or

SeniorProgramOfficer(ProvincialCIS)



ISCRequiredVotingMembers HealthInformationManagementrepresentative CISSeniorProgramOfficerrepresentative Physicianrepresentative(s) Nursingrepresentative(s) AlliedHealthrepresentative(s) AMArepresentative CPSArepresentative Information&Privacyrepresentative Regionalhealthscienceuniversityrepresentative ITClinicalServicesrepresentative Analyticsrepresentative LegalCounsel–Clinicalrepresentative HealthProfessionStrategyandPracticerepresentative Research&Innovationrepresentative …+othermembersasappropriateOtheradhocoradvisorymembersmaybeappointedorinvitedtospecificmeetingsasneeded.EachISCmaynamenon-votingsecretariat,supportorobservermembersasneeded.RolesandResponsibilitiesISCMembers

• Reviewallpertinentbackgroundinformationrelativetopre-circulatedagendapriortomeeting,enablingcomprehensiveandtimelydiscussionandcollaborativedecision-making.

• Advisetheco-chairsifunabletoattendandprovideforattendanceofaninformedalternate.

• Contributetothedevelopmentofpolicy,standards,andrecommendationsforparentCISGovernanceCommitteeactionandapproval.

• Communicateresultingpoliciestoallassociatedstakeholderswithinrespectiveareaofrepresentation.

ISCChairandCo-chair• Determinemeetingscheduleandsetmeetingagenda.• Ensureappropriatecommitteerepresentationrelevanttosubjectmatter.• Confirmquorumismet.• Reviewmeetingminutesforaccuracy.• EscalateissuesthatcannotberesolvedbytheAHSISCtoappropriateseniorCISdecision

makingandgovernancecommittee(s).• SitasamemberoftheCISGovernanceCommitteewhereIreportsaretabled.• ProvideforliaisonwiththeAHHIDGCorarrangeforreportingasrequired.



• CoordinatewithotherCISISCsoninformationstewardshipissuesthathaveprovincialimplications;aligningwithAHSProvincialCISpolicieswheneverpossible.

Secretariat

• Schedulemonthlymeetings.• Managemeetingschedules.• Managemeetingagendas.• Coordinateroombookingsandtechnologyrequirements(teleconference,Telehealth,

equipmentneeds,networkaccess,etc...).• Circulateagendaandminutesofpreviousmeetings.

AgendaitemswillbeidentifiedbytheISCCo-Chairs,CommitteeMembersand/orotherCISgovernancegroups.CommitteemembersareadvisedtosubmitagendaitemsthroughtheSecretariat,butmayalsobringitemsforwarddirectlytotheco-chairsforconsideration.

MeetingFrequency

TheAHSCISISCwillmeetmonthlyorasneededatthecalloftheco-chairs.

DecisionMakingProcess

TheCISISCwilladoptinteractivedecisionmakingprocessesthatemphasizecollaboration,activecyclesoffeedback,andconstructivedebateinordertomakesounddecisionsthatarealignedwithlegislativeandregulatoryrequirements,professionalstandardsofpractice,publicexpectationsandAHSProvincialCISinformationsharingpolicies.

Quorum

Theco-chairsandatleast1oftherepresentativesfromtheAMA,CPSAandUniversityarerequiredforeachISCmeetingreachingquorum.Inaddition,quorumforeachmeetingwillrequire50%ofvotingmembersplusonewiththemajoritycarryingthevote.Atthediscretionoftheco-chairs,thevotecanbebasedontheagendatopicsandwhetherornotsufficientsubjectmatterexpertiseispresentinordertomakearecommendation.Giventhenatureofthepoliciesdiscussed,itisimportantthatISCbeallowedtocallinadditionalnon-votingsubjectmatterexpertsasneededandconsidermultipleviewpointsfromawiderangeofstakeholders(includingpatientsandthirdparties).DisputeResolution

IntheeventthattheISCandparentCISGovernanceCommitteeareunabletoresolveaninformationstewardshipissue,AlbertaHealthprovidesanavenueforformaldisputeresolutionandproblemescalation.Thisdisputeresolutionprocessisalsoavailabletohealthcareprofessionalswhohaveexhaustedallwithin-AHSoversight,deliberationandinformationstewardshipresourcesforresolvingasignificantinformationsharingissue.



ThosewishingtoinitiatetheAHdatastewardshipdisputeresolutionprocessshouldcontacttheExecutiveDirector,InformationManagementBranch,AlbertaHealth.UnresolvedissueswillbeforwardedtoHIDGCforconsiderationwiththeMinisterretainingtheauthoritytoissueabindingresolutionshouldHIDGCnotachieveconsensus.

Thisdisputeresolutionpathwaydoesnotimplylackofaccessofotheravenuesforinvestigation,suchasthoseprovidedbytheOfficeoftheInformationandPrivacyCommissioner.

Schedule “D” – Information Manager Agreement Template

AHSClinicalInformationSystemInformationSharingApproach InformationManagementAgreementTest


RequirementforanInformationManagementAgreement

underan

ApproachtoInformationSharingamongusersof


June29,2017



Purpose

AClinicalInformationSystem(CIS)isanintegratedinformationmanagementplatformenablingcollection,access,useandsharingofinformationsupportingthedeliveryofhealthservicestopersonsandpopulationsinmultiplesettingsacrossthecontinuumofcare.AlbertaHealthServices(AHS)operatesthreeexistingzonalCISs:SunriseClinicalManager(CalgaryZone),eCLINICIAN(EdmontonZone)andMeditech(North,CentralandSouthZones).AHSisbuildingandimplementinganAHSProvincialCISwhichultimatelywillreplaceallzoneCISs.

ThepurposeofthisdocumentistooutlineconsiderationsthatmustbesatisfiedinorderforaclinicianorgroupofclinicianstoneedtoenterintoanInformationManagementAgreement(IMA)withAlbertaHealthServices(AHS)respectinguseofanexistingAHSCIS.TheAHSProvincialCISwillbedesignedasatrulyintegratedcontinuum-of-carehealthinformationserviceandwillnothavehealthinformationsharingcharacteristicsorarrangementsthatwouldmeritanIMA.

ThepossibleneedforanIMArespectinganexistingCISwillbebasedupontestsofhealthinformationsharingagencyandcontrol,ratherthanconsiderationsoflocation,settingoremployment.ThefollowingdefinitionsandconsiderationswillinformdecisionsaboutIMAuseorrenewalforusersofSunriseClinicalManager,MeditechoreCLINICIAN.

AHSVirtualFacility

AnAHSCISexistswithina“virtualfacility”thatcanbeaccessedfromanywhere.AccessiscontingentuponsecureauthenticationandisnotgrantedwithoutauseraccountapprovedforaccesstoAHSnetworks(the“Intranet”)orforloggingontooneormoreAHSCISs.CISaccessmaybeauthorizedforoneormore“roles”inoneormore“departments”(sectionorgroup,e.g.“Cardiology”).TheintersectofCISroleanddepartmentdetermineswhichCISfunctions,contentandpermissionsaremadeavailabletotheauthorizeduser.Suchrightsandpermissionsmayaffectwhatusersareabletodo,andareaccountablefor,respectinghealthinformationsharing.

SuccessfulaccesstotheAHSintranetandCISinformationenvironmentshappensthroughavirtualcomputerworkstationopenedontheuser’scomputerdevice.ItiswithinthevirtualworkstationthatCISinformationsharingoccurs.This“virtualmachine”doesnotexistontheuser’scomputerhardwareornetwork;instead,theuserhasawindowintotheAHSnetworks,infrastructureandinfostructure,whichenablesallCISfunctionality.

Theabilitytoview,contributetoandshareinformationwithanAHSCIShealthrecordisnotdeterminedbyauser’sphysicallocation,suchasahospital,clinic,officeorhome.Instead,accessandinformationsharingcapabilitiesaredeterminedbytheusers’authorization,roleandgroupmembership;regardlessoftheindividual’slocation,facility,settingorcomputerdevice.



PrivacyControls

Physical,policyandprocesscontrolsthatrelatetoprivacy,confidentiality,securityandpermissionsaremanagedbyAHS.AccesstoanAHS“virtualfacility”,withinwhichAHSCISsoperate,isprovidedonlytouserswhohavesatisfiedAHSaccessrequirements.AccessisnotprovidedunlesstheuserhascompletedmandatoryAHSprivacyawarenesstrainingandanyrequiredCIS-specificprivacytraining;hasdemonstratedapplicablecompetencytraining,andhasattestedtoaconfidentialityuseragreement.Accessisremovedifprivacypoliciesorproceduresarebreached,CISuseisdiscontinued,orperiodicprivacyawarenessreaffirmationdoesnotoccur.

PatientaccesstoCISfunctions(e.g.patientportal),includingprivacycontrolsandfulfillmentofrequestsforCIScontent,isAHS-managed.Administrative,healthcareanalytics,qualityimprovementandresearchaccesstoAHSCISsisAHS-managed.PoliciesandproceduresgoverningCIShealthinformationsharingapplytotheentiredigitalhealthrecordanddonotdistinguishbetweeninformationsharedinoutpatient,inpatient,continuingcare,communityorothersettings.

ThedefaultassumptionisthatAHSCISuserscontributetoasharedrecordwheretheyserveAHS-definedroleswithinmultidisciplinary,multi-user,virtualdepartments.Theydonothaveindividualorindependentagencyorcontroloverhealthinformationsharingpolicies,proceduresorprocesses.Theyagreetoabidebypolicies,controlsandregulationsmanagedbyAHS.Accordingly,theydonotmeetrequirementsforcustodialcontrolofhealthinformation,asdefinedintheHealthInformationAct(HIA),andareconsideredaffiliatesofAHSwhilecontributing,usingorsharinginformationinanAHSvirtualfacility.

AHSProvincialCIS

TheintentandplanfortheAHSProvincialCISdoesnotcontemplatethepossibilityofcustodiansotherthanAHS.Acoredeliverableoftheinitiativeissystem-wideintegration,acrossgenerations,geographyandthecontinuumofcare.TheProvincialCIShealthrecordisindivisiblebydesignandwillnothaveinstancesorservicesthatcanbeseparatedfromthewhole.Thehealthrecordarchitecturewillnotsupportseparationorsegmentationoftheunderlyinghealthinformationdataset.

TheAHSProvincialCIS,bydesign,willnotsupportconditionsnecessaryforgroupsotherthanAHShavingcustodialagencywithrespecttoinformationsharing.Therewillbenoprovisionforsub-sectionsoftheCISwhereindependentaccess,privacycontrols,policies,datastewardshiporinformationstewardshiparepossible.Accordingly,theneedforaninformationmanagementagreementwithindependentcustodian(s)isnotanticipated.



AHSZoneCISs

Pre-existingAHSZoneCISs(including,SunriseClinicalManager,MeditechandeCLINICIAN)mayhaveexistingarrangementswithusergroup(s)thatdidnotassumethedefaultinformationsharingcontrolsdescribedabove.Itispossiblethataphysicianorphysiciangroup(“client”)havecontractedwithAHSfortheprovisionofCISservicesundertheformerInformationSharingFramework.Thecontractmayhaveassumedorassignedhealthinformationcustodialresponsibilitiestotheclient.

Theexistenceofan“independentinstance”ofanexistingAHSCISwillberecognizedwhenthefollowingconditionsaremet:

• Theclient(s)arenotsubjecttoAHSmedicalstaffbylawswhereandwhentheindependentinstanceisconfiguredforuse.

• AuniquegroupordepartmentiscreatedintheAHSCISthatislogicallypartitionedfromtherestoftheAHSCISsuchthattheclientsaresupportedtohave:

o IndependentCISconfiguration,functionorcustomizationchoices,o Independentabilitiestomakechoicesaffectinginformationsharing,security,content

back-ups(businesscontinuity)andotherfunctionalitythatwouldotherwisebecontrolledatanAHSenterpriselevel.

• Abilitytocontributeinformationwithintheindependentinstancethatcanbeuniquelyidentified,trackedandreportedon.

• AbilityforinformationsharedbytheindependentinstancetobemanagedseparatelyfrominformationintheremainderoftheAHSCIS.

• Adoptionbytheindependentphysiciansofinformationsharingpoliciesandprocedures,includingprivacytrainingandoversight,inaccordancewithSection63oftheHIA.

• PreparationandsubmissionofanindependentPrivacyImpactAssessmentandanaddendumtotheAHSCISPrivacyImpactAssessment.

• ControloverthephysicalsettingwheretheAHSCISisused,incompliancewithfindingsofaProvincialOrganizationalReadinessAssessmentpursuanttoSection64oftheHIA.

• CompletionofaCISservicelevelagreementwithAHSastheCISserviceprovider.• ExpectationthattheOfficeoftheInformationandPrivacyCommissionerwouldfindtheclient(s)

tohavehealthinformationcustodianaccountabilities,asdefinedintheHIA.

TheseconditionsdonotapplytotheAHSProvincialCIS,whichdoesnotcontemplatenon-AHScustodians.

Theconditionswillbeusedtodeterminewhetherthereisneedtocontinueorre-newanInformationManagerAgreement(IMA)foranyexistingindependentinstanceofanexistingzoneCISs(Meditech,SunriseClinicalManager,oreCLINICIAN).CreationofnewindependentinstanceswithinexistingAHSzoneCISsisnotcontemplated.



InformationManagementAgreement

IndependentphysiciansoperatinganindependentinstanceofanexistingAHSCIS,asdefinedabove,willberequiredtoratifyanIMAwithAHSbasedontheattachedIMAtemplate;orrenewanyexistingIMAtoalignwiththeattachedIMAtemplate.

TheattachedAHSCISInformationSharingIMATemplatehasbeendevelopedtooutlineexpectedcontentofanapprovedIMA.SpecificindependentinstancesofexistingAHSCISsmaymeritadditionsorclarificationstothetemplate.TheresultingratifiedIMAwillnotrestrictAHS’suseofinformationcontributedtotheAHSCIS,asauthorizedundertheHIA.



ALBERTA INFORMATION MANAGER AGREEMENT (the "Agreement")

(Secondary reference: Information Manager Services for the AHS CIS)

Dated the day of , 20__ (the “Effective Date”)

BETWEEN:

(name(s) of physician(s) within an office or clinic) (collectively hereinafter referred to as the “Custodian”)

AND

ALBERTA HEALTH SERVICES (hereinafter referred to as the “Information Manager”)

WHEREAS:

A. The Custodian provides the Information Manager with access to Health Information to enable the Information Manager to provide certain information technology services as contemplated by Section 66(1) of the Health Information Act for the Custodian’s independent instance of an AHS CIS running at the Clinic identified in this Agreement (the “Independent Instance”).

B. The Custodian is a Custodian as defined by the Health Information Act. C. The Information Manager is also a regional health authority created pursuant to the Regional

Health Authorities Act (Alberta) and the Custodian for the purposes of the AHS CIS. D. Section 66(2) of the Health Information Act requires the Custodian to enter into an agreement

with an information manager for the provision of services relating to the management of health information.

E. The intent of this Agreement is to satisfy the requirements of the Health Information Act and to

govern the provision of Health Information from the Custodian to the Information Manager in relation to the Independent Instance. NOW THEREFORE THE PARTIES TO THIS AGREEMENT WITNESS THAT in consideration of the premises and of the mutual covenants and agreements herein contained and for other good and valuable consideration, the receipt and sufficiency of which is hereby irrevocably acknowledged, the Parties hereby covenant and agree as follows:

Definitions

1. Except where noted, capitalized words and phrases used herein which are defined in section

1 of the Health Information Act have the same meaning in this Agreement.



2. In this Agreement:

a) “CIS” means an integrated clinical information management platform supporting the collection, access, use and disclosure of information supporting the delivery of health services to persons and populations in multiple settings across the continuum of care.

b) “AHS Provincial CIS” means a single one-person-one-record-one-system CIS

operated by AHS throughout the Province of Alberta.

c) “Agreement” means this Information Manager Agreement between the Custodian and the Information Manager dated the Effective Date.

d) “Clinic” means the Custodian’s facility supported by the Independent Instance as

further identified in Schedule “A” attached to this Agreement.

e) “Health Information Act” or “HIA” means the Health Information Act, R.S.A. 2000, c. H- 5, as amended from time to time, and the regulations thereunder.

f) “Independent Instance” has the meaning ascribed to that term in Schedule “A” attached

to this Agreement, which includes having a partitioned segment of a CIS dataset that can function without access to the rest of the CIS dataset.

g) “Information Management Services” means the information management or information

technology services provided by the Information Manager to the Custodian in respect of the Independent Instance as further described in Schedule “A” to this Agreement.

h) “Schedule “A”” means Schedule “A” attached to, and forming a part of this Agreement.

Appointment of Information Manager

3. The Custodian hereby appoints the Information Manager as an information manager for

the purposes of providing the Custodian with Information Management Services solely in relation to the Independent Instance.

Objectives and Guiding Principles of Agreement 4. The objectives and guiding principles of this Agreement are as follows:

a. to comply with section 66 of the HIA with respect to the provision of services to the Custodian by the Information Manager as further described in Schedule “A” of this Agreement;

b. acknowledge that the Information Manager is not only an information manager but is

also a custodian for the purposes of the HIA and as such, the custodian of the Health Information in the AHS CIS;

c. for the purposes of facilitating the disclosure of Health Information between the AHS

CIS (where AHS is the “custodian” for the purposes of the HIA), and the Independent Instance (where the Custodian is the “custodian” for the purposes of the HIA), the parties agree they are relying upon Section 35(1)(a) of the HIA; and



d. the parties agree that the Information Manager, acting in its capacity as custodian of the Health Information in the AHS CIS, can use the Health Information in the Independent Instance disclosed to the Information Manager by the Custodian pursuant to Section 35(1)(a) for any of the purposes that are permitted under the provisions of the HIA.

Compliance with Applicable Laws

5. The relationship of the Custodian to the Information Manager pursuant to the terms of this

Agreement is solely that of custodian to information manager. The Information Manager shall at all times comply with the HIA, the regulations and with the policies and procedures established or adopted by the Custodian under section 63 of the HIA.

6. The parties shall comply with the provisions of the HIA, including without limitation, in the

processing, storage, retrieval or disposal of Health Information, including the stripping, encoding and transformation of individually identifying Health Information to create non-identifying Health Information, and the provision of information management or information technology services.

7. Nothing in this Agreement absolves the parties from complying with other statutory, legal or

contractual requirements. 8. In providing the Information Manager Services in accordance with this Agreement, the

Information Manager may need to have access to, or may need to use, disclose, retain or dispose of Health Information in accordance with the Custodian’s policies and procedures.

Services to be Provided 9. The Information Manager shall provide Information Management Services to the Clinic in

accordance with the terms and conditions on this Agreement and as further described in Schedule “A” attached to this Agreement.

10. The Information Manager may charge a fee for the Information Management Services

and such fee shall be set out in Schedule “A” to this Agreement. 11. For the purposes of this Agreement and the provision of the Health Information

Management services as set out herein, the parties agree and acknowledge that as and when the Independent Instance synchronizes with the AHS CIS, such synchronization constitutes a collection by the Information Manager, acting in its capacity as the custodian of the AHS CIS, and a disclosure by the Custodian pursuant to section 35(1)(a) of the HIA.

12. The Information Manager shall provide Information Manager Services with reasonable care,

skill and diligence to a professional standard and maintain a high degree of data accuracy in handling Health Information.

Confidentiality

13. The Information Manager shall treat all Health Information in the Independent Instance

that it has access to under this Agreement as confidential except as otherwise provided in this Agreement. Only those employees or agents of the Information Manager who are engaged in Information Manager Services shall have access to Health Information. The Information Manager shall take all reasonable steps to prevent an unauthorized disclosure of Health Information.



14. For the purposes of providing the Information Management Services, the Information

Manager shall limit its use and disclosure of Health Information to only the minimum necessary Health Information required by the Information Manager to furnish such services or resolve support issues on behalf of the Custodian, except as otherwise provided in this Agreement.

15. Should any disclosure of Health Information occur, the Information Manager shall forthwith

provide immediate notification to the Custodian, including the particulars of the disclosure. The Information Manager shall take all reasonable steps to mitigate the disclosure immediately and on an ongoing basis, as required.

16. The Information Manager may provide Health Information to any other Information

Managers used by the Custodian with written authorization by the Custodian. 17. Any expressed wishes from a patient relating to Health Information will be directed to the

Custodian. The Information Manager will not take any other action without authorization by the Custodian.

Patient Requests for Information

18. Any requests from a patient for access to, or correction of, Health Information will be directed to the Custodian for further handling in accordance with the Custodian’s policies and procedures established by the Custodian pursuant to Section 63 of the HIA.

19. The Information Manager shall inform the Custodian of all patient requests for Health

Information, including requests to amend or correct Health Information, as soon as is reasonably practicable in accordance with the Custodian’s policies and procedures for responding to such requests.

Audit

20. To the extent applicable to the information technology, the Information Manager agrees to permit the Custodian to audit its performance of this Agreement solely as it relates to the Independent Instance, including providing reasonable access to the applicable facilities of the Information Manager solely as they relate to the provision of the Information Management Services. Notwithstanding the foregoing, the Custodian agrees and acknowledges that the Information Manager, acting in its capacity as the custodian of the AHS CIS also has the right to audit the Custodian’s use of the Independent Instance to the extent the Custodian’s activities in the Independent Instance have the potential to impact the security and privacy of the Health Information in the AHS CIS.

21. The Custodian may assign its right to audit under section 20 to its employees, agents

and contractors. 22. Nothing in this Agreement shall be interpreted to limit the right of the Auditor General of

Alberta or the Office of the Information and Privacy Commissioner of Alberta to conduct an audit or investigation.

23. To the extent applicable to the information technology, the Custodian has the right to

monitor and generate an audit trail of the Information Manager’s access of Health Information. Routine audits may be conducted to verify that Health Information has only



been used in the manner contemplated by this Agreement. Protection and Security of the Health Information

24. The Information Manager, its employees, subcontractors, and agents must protect the Health Information against such risks as unauthorized access, use, disclosure, destruction or alteration.

25. The Information Manager must limit access to the Health Information only to those

employees, subcontractors or agents of the Information Manager who have a need to know. 26. The Information Manager, its employees, subcontractors, and agents have a duty to protect

Health Information that must be equal to or greater than the Custodian’s obligations in section 60 of the Health Information Act and section 8 of the Health Information Regulation.

27. For the purposes of the Information Management Services, the Information Manager, its

employees, subcontractors, and agents must not modify or alter the Health Information unless that is required as part of the services and only on the written instructions of the Custodian(s) providing the Health Information. Specifically:

a. The Information Manager will ensure that its employees, subcontractors, and

agents who may be in contact with the Health Information are informed of the need to fulfill the Information Manager’s obligations as set forth herein;

b. To the extent applicable to the Independent Instance, the Information Manager will comply with the Custodian’s(s’) policies and procedures for access to the Health Information and with the physical security and access controls and the information technology security and access controls that are set out in the Custodian’s policies and procedures; and

c. The Information Manager will notify the Custodian(s) in writing immediately if the Information Manager or its employees, subcontractors or agents become aware that any of the conditions set out in this Agreement or in any of the Custodian’s security and privacy policies and procedures have been breached.

Retention and Disposition of the Health Information

28. No Health Information shall be permanently stored outside the Province of Alberta. Health Information may be temporarily stored, as copies, on servers outside of the Province of Alberta as part of the provision of Information Services. This Health Information will be deleted as soon as the Information Services have been have been provided and the temporary data storage for Health Information shall not be subject to back-up. In any case, the provisions of this Agreement will apply to any information temporarily stored outside the Province of Alberta.

29. The Information Manager will ensure that all Health Information extractions or copies that

are no longer required are destroyed. The Information Manager will provide to the clinic a written certificate of destruction of any and all remaining data in the Information Manager’s control.

Term and Termination



30. This Agreement shall commence on the Effective Date and continue for the period set out in Schedule “A” (the “Term”) unless terminated earlier in accordance with this Agreement.

31. The parties may terminate this Agreement upon mutual agreement in writing. Either party may terminate this Agreement upon ninety (90) days written notice to the other party at its normal place of business by registered mail.

32. Upon termination of this Agreement, the Information Manager shall provide access to

Health Information contributed by the Custodian, as authorized or required by legislation or regulation.

33. The Custodian agrees to be liable to, and indemnify and hold the Information Manager, its

employees, subcontractor, agents, and suppliers harmless from any and all claims, demands, suits, actions, causes of action or liability of any kind whatsoever for damages, losses, costs or expenses (including legal fees and disbursements), or other amounts that may arise, directly or indirectly as a result of:

a. any breach of applicable law; b. any breach of this Agreement; c. any unauthorized collection, use, or disclosure or alteration of Health Information; d. any unauthorized exchange of Health Information; e. any unauthorized access to the Independent Instance; f. any breach of the security or privacy of Health Information the Custodian has entered or

has provided access to through the Independent Instance; or g. any unauthorized alteration (including, without limitation, unauthorized access) of the

Health Information the Custodian has contributed to the Independent Instance, by or caused by the Custodian, its employees, agents or others for whom the Custodian is legally responsible.

General Provisions

34. Every request, notice, delivery or written communication provided for or permitted by this

Agreement shall be in writing and delivered to, or mailed, postage prepaid, emailed or faxed to the party to whom it is intended to the address set forth in Schedule “A”.

35. This Agreement shall not be modified, amended, or in any way varied or changed, except

by a duly written executed instrument by the parties. 36. The terms and conditions of the Agreement shall be subject to and construed pursuant to

the laws in force in the Province of Alberta. 37. Each provision of this Agreement shall be severable from every other provision of this

Agreement for the purpose of determining the legal enforceability of any specific provision unless to do so affects the entire intent and purpose of this Agreement.



38. This Agreement may not be assigned by either party without the prior written consent of the other party.

39. This Agreement and the information contained herein may be made generally available to

the public. The parties each agree that this document does not contain proprietary information and may be made available to the public at the Information Manager’s discretion.

40. This Agreement sets forth the complete understanding of the parties with respect to this

subject matter and supersedes all other all prior and contemporaneous agreements, written or oral, between them concerning such subject matter. In the event of any conflict between the provisions of this Agreement and the provisions of any other agreement between the parties, the provisions of this Agreement shall control.

41. No consent or waiver, express or implied by any party of any breach or default by the other

party in the performance of any obligations hereunder shall be deemed or construed to be a consent or waiver to any other breach or default in the performance by such other party of the same or any other obligation of such party hereunder. Failure on the part of any party to complain of any act or failure to act of any other party or to declare any party to be in breach or default, irrespective of how long such failure continues, shall not constitute a waiver by such party of its rights hereunder. No failure or delay by a party in exercising any of its rights or pursuing any remedies available to it hereunder or at law or in equity shall in any way constitute a waiver or prohibition of such rights and remedies in the event of a breach of this Agreement.

[Thisspaceintentionallyleftblank–Section42andsignaturesonfollowingpage]



42. This Agreement may be executed in any number of counterparts, all of which taken

together will be deemed to constitute one and the same instrument. Delivery of an executed signature page to this Agreement by any party by electronic transmission will be as effective as delivery of a manually executed copy thereof by such party.

ALBERTA HEALTH SERVICES

By: Name: Title:

Date:

By:

Name: Title:

Date: Custodian - Date: (Print Name) Custodian Signature Witness



Schedule “A” Description of Services to be provided by the Information Manager

Term: XXXX years Clinic: [Insert name and location of Custodian’s facility here] Information Management Services: [insert description of services here] Fees: [to be determined] Addresses for Notice: If to the Custodian: [Complete address for notice of Custodian here including fax # and email] If to the Information Manager:

Alberta Health Services Information and Privacy Office 10101 Southport Road S.W. Calgary, AB T2W 3N2 Phone: 403 943-0424 Fax: 403 943-0429

Documents

Memorandum of Understanding Regarding an Approach to