Canadian Real World Consent Directive Scenarios by Pat Pyette
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Real World Consent Directive Scenarios
The following scenarios are based on existing jurisdictional policy and are realized in existing systems in Canada. The default policy is one of implied consent for the provision of care, so these scenarios all deal with withdrawal or withholding consent for that purpose. In other jurisdictions, where an express consent model is used (Opt-In), these would examples would contain the phrase "consent to" rather than "withhold" or "withdraw" consent for.
1) Withhold or withdraw consent for disclosure of records related to specific domain (e.g. DI, LAB, etc.)
Eve Everywoman wishes to withhold disclosure of all of her lab orders and results to any provider.
2) Withhold or withdraw consent for disclosure of a specific record (e.g. Lab Order/Result)
Adam Everyman's Primary Care Provider, Dr. Philip Primary, has ordered a set of lab test which Adam wishes to keep as private as possible. At the sample collection facility, he indicates that he would like withhold consent to disclose the order and all results associated with that specific order from all other providers
3) Withhold or withdraw consent for disclosure to a specific provider organization
Adam Everyman's ex-spouse is a Physician that is employed by Good Health Clinic. Adam decides that he would like to withdraw/withhold consent to disclose any instance of his health information to Good Health Clinic.
4) Withhold or withdraw consent for disclosure to a specific provider agent (an individual within an organization)
Eve Everywoman's ex-spouse, Bill T Lookafter is a Nurse that is employed by Good Health Hospital. Eve realizes that she may receive treatment at GHH, however she does not want her ex-spouse to have any access to her IIHI. She indicates that she would like to withdraw/withhold consent to disclose any instance of her health information to her ex-spouse as a result of his employment at Good Health Clinic.
5) Withhold or withdraw consent for disclosure of records that were authored by a specific organization (or service delivery location).
Adam Everyman wishes to have all of the PHI collected at the Good Health Psychiatric Hospital restricted from disclosure to every provider.
Example-Consent-OptIn-NotAuthor
6) Combinations of the above
Adam Everyman's Primary Care Provider, Dr. Philip Primary, has ordered a set of lab test which Adam wishes to keep as private as possible. At the sample collection facility, he indicates that he would like withhold consent to disclose the order and all results associated with that specific order from all other providers, with the exception of his Internist's clinical group, Illinois Internists.
N.B. The assumption in each of these scenarios is that any Provider that orders a test or is copied on the order would not be subject to withdrawal or withholding of consent to disclose as their access would be considered a "use" rather than a "disclosure".
