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MSHR Open Clinical Documents - Provider FAQs

Q. Why are clinical documents being added to MySaskHealthRecord?

Since the inception of MySaskHealthRecord (MSHR), patients have asked for access to their clinical documents from their appointments, so that they can continue to play an active role in managing their own healthcare. In its 2022-23 accountability plan, the Ministry supported making clinical documents—currently in eHR Viewer— available to patients in their MSHR account.

Patients already have the ability to access their personal health information through the Release of Information (ROI) process via SHA's Privacy and Health Information Management department. The addition of certain document types in MSHR will make it easier for patients to access their health information.

Many other jurisdictions in Canada already provide patients online access to their clinical documents.

Q: What new information will be available for patients in MSHR and when?

Clinical notes that are currently in the eHR Viewer, will be available in MSHR in a phased approach. The planned phases and timelines are shown below.

Q. Will fee-for-service/private clinical documents be available in MSHR?

Document types that are in the eHR Viewer will be made available in MSHR. Clinical documents in private EMRs that are not in the eHR Viewer will not be available in MSHR at this time.

Q: Will clinical documents authored prior to rollout be made available in MSHR?

Clinical documents finalized before rollout will not be available in MSHR.

Q: Will there be a time lag or delay for when clinical documents become available in MSHR? 

There will be a 48-hour delay after a clinical document is finalized to when it will be available on MSHR. There is currently no delay on most MSHR content, such as laboratory and imaging results, but there is a four-day delay on pathology reports.

Q: Who will have access to clinical documents in MSHR?

Currently, any person who is 14 years or older is able to create a MSHR account. All registered MSHR users will have access to their own clinical documents. Additionally, any other user with whom they have opted to share their clinical documents, will have access to those clinical documents.

Where authorized, eHealth may provide an individual with access to another person's MSHR. This includes:

• The legal custodians of a minor under age 14.
• Those legally responsible (i.e., personal guardians or healthcare decision makers) for providing ongoing day-to-day care to an individual who does not have capacity and is not expected to regain it.
  

Q: Who can request access to MSHR on behalf of other individuals?

Section 56 of The Health Information Protection Act (HIPA) allows others to act on behalf of an individual in certain circumstances. When it comes to MSHR, the following circumstances could permit eHealth to provide access to another's MSHR:

• The parents/legal guardians of minors under age 14.
  
• The parents/legal guardians of minors between age 14 and 17 who do not have capacity.
  
• The personal guardian appointed for an individual who does not have capacity.
  
• The substitute decision maker, who is entitled to make a healthcare decision pursuant to The Health Care Directives and Substitute Health Care Decision Makers Act, 2015, on behalf of an adult who does not have capacity.
  

Individuals requesting access on behalf of another person must provide evidence of their authority to act on their behalf.

Q. What happens if an adolescent or adult patient has medical conditions preventing them from registering for their own account?

Those responsible for making healthcare decisions of someone who does not have capacity should contact the eHealth Privacy Service for assistance with submitting their request. Once confirmed as authorized, the eHealth Privacy Service will provide the proxy with access to the individual's MSHR. The eHealth Privacy Service can be reached by email at privacyandaccess@eHealthSask.ca or phone 1-855-347-5465.

Q: Is there a time when a patient may not be able to view their clinical document on MSHR? How will sensitive documents be managed in this process? Can I decide which clinical documents my patient receives?

There are circumstances in HIPA that could prevent the release of all or part of a clinical document. 

Authors using SCM, Fluency for Transcription/Fluency Mobile or Fluency Flex will be able to exclude clinical documents from MSHR in accordance with HIPA criteria.

Where a record does not exist in MSHR, patients still have a right to request a copy directly from a trustee. As an example, a patient may request a copy from the responsible provider's EMR. Providers can then follow the criteria in HIPA to apply necessary redactions, while providing access to as much of the record as possible.

Q: Will there be training for providers on when and how to exclude clinical documents from MSHR?

Yes. Authors using SCM, Fluency for Transcription/Fluency Mobile or Fluency Flex will be able to exclude clinical documents from MSHR in accordance with HIPA criteria. Self-directed training will be available in MyConnection at least four weeks prior to go-live to show users when and how to exclude documents in the eHR Viewer from MSHR in accordance with HIPA criteria. You can also find a Guide for excluding clinical documents from MSHR along with a One page overview for excluding clinical documents from MSHR.

What if there is information in the patient's clinical document that may be upsetting or surprising to a patient? Will we be expected to censor our documents?

Sensitive or difficult issues would ideally be discussed in advance of a patient reading the information in MSHR. There is a 48-hour delay between clinical documents being approved by the healthcare provider, submitted to the eHR Viewer, and then appearing in MSHR. This time could be used to update the patient and share any potentially concerning information in the clinical document. We recognize this could necessitate a change in your normal process and appreciate your consideration of the patient's response. Information is available on the MSHR provider page on how to address abnormal or sensitive information with patients.

Q: Will this include hand-written progress notes?

Not at this point in time. Only document types that are in the eHR Viewer will be made available in MSHR.

Q: Will it be possible to attach guides (e.g. fasting guides) to the patient's documents?

Not at this point in time. Only document types that are in the eHR Viewer will be made available in MSHR.

Q: Will I need to make any changes to the way I dictate clinical documents?

It is important to dictate your clinical documents as soon as possible after your patient visit. Patients will be informed that their clinical documents will be available 48 hours after the healthcare provider has finalized the notes.

We have created a guide with some patient-centred writing tips for providers. These tips are based on what providers in other jurisdictions found helpful when clinical documents were shared with patients.

Q: What should I do if I notice an error in a note I've authored, another provider has authored, or if my patient alerts me to an error?

Please refer to the following one page handout outlining how errors in SHA clinical documents can be managed:

• How a provider can correct a note they've authored
• How a provider can bring awareness to an error made by another provider

Patients will be able to request a correction by contacting eHealth at: 1-844-767-8259, or MySaskHealthRecord@eHealthSask.ca.

Q: Will this make extra work for providers, or their office staff, by triggering more questions and concerns from patients? 

From an environmental scan of other jurisdictions and feedback from the Saskatchewan Cancer Agency pilot (launched in May 2023), it is not anticipated that this will create additional workload.

For example, at Interior Health Authority in B.C., where a comprehensive system was put in place in 2016 to support responses to patient-identified errors, a low volume of two to four errors were reported each month. The Saskatchewan health system learned how to mitigate risks and minimize the burden for healthcare providers when previous open clinical documents, such as laboratory, imaging, and pathology reports, were made available to patients with the launch of MSHR in 2019.

There is potential for reductions in work, as patients may be better prepared at scheduled appointments to communicate results or treatments and experience the benefits of active involvement in their own care.

We have a MSHR FAQ guide for medical office staff to help answer typical questions that patients may have.

Q: How will patients see clinical documents in MSHR?

Patients will receive a notification of new content, if they have enabled the notification function in MSHR. They can then log in to their MSHR account and navigate to the "Clinical Documents" tab on the home screen. Any data available will be visible in a list on that page.

Q: How can patients get access to SHA clinical documents if they do not have a MSHR account? 

Clinical documents are also available in other clinical systems, such as SCM or the eHR Viewer. Patients can still utilize the existing manual process to request access to their clinical documents from a trustee. Here are some

other options available:

• Patients can request access to hospital records from the Health Records Department of an SHA facility. More information and their request forms are available on their website at: Health Information Services (Health  Records) | SaskHealthAuthority
• The eHR Viewer contains SHA clinical documents. The request form and more information about requesting access to personal health information in the eHR Viewer is available on the eHealth website at: Privacy and Access to Information Requesting access to information (ehealthsask.ca)
  

Q: Is there a forum for me to ask further questions I may have about open clinical documents and what it means to my practice?

We welcome all questions. Please forward your questions with the subject line "open clinical documents project questions" to MySaskHealthRecord@eHealthSask.ca.

If you have any privacy related questions, please contact the eHealth Privacy Service at: privacyandaccess@ ehealthsask.ca or call Toll Free: 1-855-347-5465