Guide
Patient confidentiality
Patient confidentiality is the rule that health information stays inside the relationship and the people who need it to provide care — unless the law or the patient says otherwise. In a Canadian clinic that conversation now includes PHIPA or another provincial health-privacy statute, PIPEDA when a commercial organization is in the mix, and sometimes HIPAA because a vendor or a patient is in the United States. This is a working high-level map for clinicians, not a legal opinion.
Circle of care, in practice
Circle of care is the shorthand Ontario clinicians use for the custodians and agents who may share personal health information to treat the patient, without a new consent conversation every time, when it is reasonable to believe the patient would not object. It is not a group chat. A specialist you referred to is in. A friend of the patient who called the front desk is not. A spouse is not automatically in. An AI vendor is not in unless they are your agent under a contract your privacy office accepts.
- Need-to-know still applies inside the clinic. Front-desk staff do not need the psychiatry formulation.
- Students and locums are agents of the custodian when they are working for you — train them.
- Faxing the whole chart 'because they asked' is not circle of care. Send what the purpose requires.
- Breaks of confidentiality (duty to warn, child protection, some driving reports) are statute-specific. Document the authority.
PHIPA, PIPEDA, HIPAA — high level
| Statute | Who it is for | What clinicians use it for |
|---|---|---|
| PHIPA (Ontario) | Health information custodians in Ontario | Collection, use, disclosure of PHI; circle of care; patient access |
| Other provincial health acts | e.g. Alberta Health Information Act, BC PIPA + eHealth, Quebec Law 25 / health acts | Same job, different wording — follow your province |
| PIPEDA | Federal private-sector; commercial activity | Vendors, apps, and organizations that are not provincial custodians |
| HIPAA (US) | US covered entities and business associates | US care, US vendors, BAAs — does not replace PHIPA in Ontario |
A Canadian physician using a US-hosted app can find all three in one stack: you remain a custodian under provincial law, the vendor talks about HIPAA because that is their US product language, and PIPEDA may apply to the company. 'HIPAA compliant' on a homepage is not a PHIPA analysis. Ask for the current DPA, residency, subprocessors, and breach process.
Not legal advice
Colleges, CMPA, CNPS, and your privacy officer own the local rules. This page does not decide whether a specific disclosure is allowed.
AI vendors
Putting a visit into a model is a disclosure to that vendor (or a use by your agent, if the contract is written that way). Treat it like any other cloud EMR add-on: consent or notice as your policy requires, a written agreement, a known region for data, and a retention story for audio. Consumer chatbots are not agents. Do not paste a chart into them.
- Tell the patient if the visit is recorded to draft the note. Stop if they decline.
- Do not send identifiers to a tool that is not under contract.
- Minimum necessary: the visit, not the entire CPP, unless the workflow needs it.
- Access logs: who in the clinic can see transcripts.
- Exit: what happens to drafts if you cancel the vendor.
Scribeberry publishes HIPAA, PIPEDA, and SOC 2 Type 2 statements on its security page. Your clinic still completes its own review. Confidentiality is not outsourced because the draft was accurate.
Everyday leaks
- Screens in the hallway, printers at reception, leftover labels.
- Emailing notes to a personal account to 'finish at home.'
- Family members used as interpreters without asking the patient.
- Dictating in a coffee shop.
- Forwarding a specialist letter to an employer because the patient 'needed it for work' without a proper request.
A scribe that stays under contract
Scribeberry is built as a clinical documentation vendor, not a consumer chatbot. Consent, review, then the EMR. Pro is $99/month after the free trial. Read the current security page with your privacy officer.
Frequently asked questions
What is the circle of care?
In Ontario practice it is the custodians and agents who may share personal health information to provide care, when it is reasonable to believe the patient would not object. It is not an open list, and vendors are not in it without a proper agency/contract relationship.
Does HIPAA apply in Canada?
HIPAA is US law. It matters when you or your vendor are in that system. It does not replace PHIPA, other provincial statutes, or PIPEDA for Canadian care.
Can I use ChatGPT on a patient chart?
Not on a consumer account. That is a disclosure to a tool that is not your agent. Use only vendors under contract, with notice/consent as required.
How does an AI scribe affect confidentiality?
The visit audio and draft become PHI held by you and, under contract, the vendor. Inform the patient, review the note, and keep the signed record in the EMR.
Templates
