impermissible disclosure or use of protected health information, by a covered
entity or its business associates.138 Second, HITECH also gave individuals
more control over their health information by improving their right to see
who has obtained copies of their records, as well as requiring them to be
notified in the event of a data breach.139
Health IT adoption is growing in Canada, but challenges remain. As a
commonwealth form of government, Canada faces certain procedural
obstacles in moving towards a digital health system.140 For example, Canada
has one of the most trusted relationships with the United States, but Canada’s
reaction to foreign legislation, which has bearing on data exchange, has
impeded intergovernmental exchange of health information.141 However,
concerns over the PATRIOT Act demonstrate how important trust is to the
free exchange of data.
1. Health IT Utilization in Canada
Like other countries, the Canadian healthcare system is encouraging
robust health IT use to improve quality and patient care.142 Health IT use in
Canada nearly doubled from 2009 to 2015 through investments by the
provinces, territories, and the federally-chartered Canada Health Infoway.143
The board of Canada Health Infoway represents both the national
government as well as the provincial and territorial governments,144 and this
structure has helped reduce some potential variation across the country.145
138. HITECH Breach Notification Interim Final Rule, U.S. DEP’T HEALTH & HUMAN
l-rule-update/HITECH/ index.html (last visited Nov. 18, 2016).
139. 42 U.S. C. A. §§ 17932, 17935, & 17937; see also Johnson, supra note 131.
140. See Sara Allin and David Rudoler, The Canadian Health Care System, 2015, in ELIAS
MOSSIALOS ET AL., EDS, INTERNATIONAL PROFILES OF HEALTH CARE SYSTEMS 27 (2015)
(“Provinces and territories are responsible for developing their own electronic information
systems, with support from Canada Health InfowayFalse”), http://www.commonwealth
141. See USA PATRIOT Act of 2001, Pub. L. No. 107–56, 115 Stat. 272 (2001).
142. See OFFICE OF THE INT’L COORDINATOR FOR HEALTH INFO. TECH., HEALTH IT
ENABLED QUALITY IMPROVEMENT: A VISION TO ACHIEVE BETTER HEALTH AND HEALTH CARE
143. Riley Denver, Family Doctors See Improvements for Patients, But Canada Still Lags
Peer Countries on Most Measures, CANADIAN INST. FOR HEALTH INFO. (Jan. 28, 2016),
144. Board of Directors, CAN. HEALTH INFOWAY, https://www.infoway-inforoute.ca/en/
about-us/about-canada-health-infoway/board-of-directors (last visited Nov. 2, 2016).
145. Joshua Vest, Health Information Technology in the International Context, in 12