New Drug Funding Program (NDFP) e-claims Solution Project PIA Summary

Background

At Ontario Health, the NDFP is one of three reimbursement programs under the Provincial Drug Reimbursement Program (PDRP). The NDFP provides a mechanism for reimbursing regional cancer centres and hospitals for cancer drugs. MOHLTC created the program to provide patients with equal access to injectable cancer drugs that are administered by hospitals.

Over time, it was clear that the NDFP’s processes and resources did not adequately meet the escalating demands of the increased volume of newly funded medications and the patients requiring them. Ontario Health initiated the NDFP e-claims Solution Project to improve NDFP performance and to attain the goal of managing cancer drug claims more efficiently.

Key Findings 

The PIA concludes that Ontario Health has the PHIPA authority to provide the services of the e-claims solution application to hospitals participating in the NDFP in order to enable clinicians (pharmacists and physicians) to have access to their patient’s historical treatment records retained within the NDFP database submitted by other treatment facilities (HICs). Ontario Health has this authority as a “health information network provider” and as an agent to the HICs pursuant to subsection 6(2) of PHIPA. In addition, Ontario Health has the authority to continue to operate the NDFP as a section 45 prescribed entity.

Risks & Recommendations 

The following summary identifies the PIA recommendations:  

1. The program should ensure that Ontario Health executes License Agreements with hospitals prior to granting access to the e-claims application. The following additional provisions should be included in the Terms of Use for the eclaims application and the License Agreement between Ontario Health and the hospitals: identifying that all participating hospitals agree to and provide Ontario Health the direction to make a patient's treatment history available to the clinician(s) subsequently providing care and request reimbursement through the NDFP for the same patient; that the application must restrict access only to the clinicians with a patient's circle of care; and that Ontario Health will act as the agent for the hospitals in their provision of the services of the eclaims application. These recommendations have been implemented.
2. The program should provide notice to the public through public disclosure channels in consultation with Ontario Health's Privacy Office as to the intended disclosure of a patient's NDFP treatment history to hospitals requesting reimbursement through the NDFP. This recommendation has been implemented.
3. Ontario Health should clarify FIPPA's applicability to Ontario Health through an amendment to PHIPA and/or its Regulation. Ontario Health has provided the Ministry of Health and Long-Term Care (MOHLTC) a formal submission.
4. NDFP should clarify with the MOHLTC its authority to request PHI related to the Exceptional Access Program (EAP) from Ontario Health. This recommendation has been implemented.

NDFP to advise the Privacy Office if and when new linkages occur between PHI in the NDFP Data Holding and existing Ontario Health data holdings and whether a permanent data holding will be created after any such linkages. On-going engagement of the Privacy Office as required. 

Ontario Health’s Information Security Office to complete a security assessment on the eclaims application. A Technical Vulnerability Assessment (TVA) will be completed prior to the launch of the eclaims application.