A Toronto-based medical records storage firm that’s been named in a privacy-related advisory in Saskatchewan is also receiving attention in Ontario for past complaints about high fees.
DOCUdavit Services Inc. was claiming too much power when selling services to Saskatchewan-based physicians, says Gary Dickson, the province’s Information and Privacy Commissioner.
“It appears that [DOCUdavit] does not comply with HIPA (the Health Information Protection Act) and does not satisfy all regulatory requirements,” the advisory issued by Saskatchewan’s Privacy Commissioner says.
It suggests that any health information trustee that entrusts the firm with medical records is also likely in breach of the Act.
Dickson’s office released the advisory relating to DOCUdavit Wednesday night. It had received complaints from patients who had been informed, through a letter, that their records had been handed over to the company. It’s normal for a doctor to use an information management service in Saskatchewan — but DOCUdavit is different.
“The difficulty comes when the contractor is setting themselves up to have the same powers as a trustee,” Dickson says. “A trustee has powers to make decisions about the disclosure of that information.”
DOCUdavit is not considered a “trustee” under HIPA, he adds. But its contracts contain unclear language and sometimes assume the responsibilities of a trustee.
DOCUdavit has taken over patient records for four doctors in the province, says Sid Soil, vice-president of sales and marketing for the Toronto-based firm. An average doctor cares for between 1,000 and 1,500 patients.
“We’re going to make all efforts to comply with the report,” Soil says. “A lot of it is just modifications to language in our agreement.”
DOCUdavit complies with Ontario’s health privacy Act, according to the province’s Information and Privacy Commissioner’s office.
But the Privacy Commissioner’s office has had past dealings with the firm having to do with complaints about fees charged for access to records.
It is common practice for a physician who retires or closes up shop to employ a medical information storage service to keep patient records. In both Saskatchewan and in Ontario, health privacy legislation allows for a “reasonable fee” to be charged if a patient wants to access their records. However, no law in either province defines what is reasonable.
“People who request their health records and are being charged a fee can file a complaint with our office if they think the fee is too high,” says Brian Beamish, assistant commissioner in Ontario. “We’ve been able to resolve these issues through mediation.”
Cost complaints over medical records is an issue the office regularly deals with, he says adding that it would be prefeable if the government did pass legislation and set up a set fee schedule.
DOCUdavit charges a $20 access fee, and an additional 50 cents per page of medical records, Soil says. But the firm puts a cap on the maximum that can be charged – $75 for an individual and $150 for a family of four.
“In general, we find patients don’t understand that they have to pay for this,” Soil says. “If the fee is too much for a patient, they’ll call us and we can make accommodations for them.”
But some Saskatchewan complainants cited being asked to pay higher fees for their records, Dickson says. The patients “talked about different numbers than $75 and $150… we have to find out if that’s the case.”
Soil denies that DOCUdavit ever charges over those maximum limits. Additional fees could include a $18 courier charge, and taxes.
In letters sent to Saskatchewan patients, DOCUdavit described its fees as reasonable under provincial law. But the commissioner’s advisory states “we have no idea on what basis DSI can assert that its fees are authorized by HIPA.”
There’s no clear law on what a reasonable fee is in Saskatchewan, Dickson says, and “no determination that the fees charged by DOCUdavit are reasonable fees.”
The firm has been doing business in Saskatchewan for six years, Soil says, but has never done a lot of business in the province. Over the last month, it has attained some new customers and became aware that Dickson’s office was doing a write-up about its practices.
DOCUdavit is stepping into the province to help address a problem of abandoned patient records, he adds. “Doctors are looking for somewhere to store records.”
The firm has been in contact with its doctors in the province recently and none have asked to withdraw their services, Soil says. But it will not seek new business in the province until resolving the issue with the commissioner’s office.
To do that, DOCUdavit will have to rework the language in its contracts and change its business practices, Dickson says. “They’re to store the records and convert them to digital form, and that’s the extent of what they can do.”
Saskatchewan physicians who pass records on to a storage service like DOCUdavit are still responsible for those patient records, Dickson says. The Toronto firm can’t assume the liability for the records.
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