The Top 3 Agreements Your Healthcare Practice MUST Have (and Why)

The Top 3 Agreements Your Healthcare Practice MUST Have (and Why)

In order to provide services, healthcare practices must collect pertinent information from patients. This data gathering often includes many sources of information, across different types of technology, among multiple vendors. Good business practices and health records management is supported by three agreements your healthcare must have: information manager agreement (IMA), information sharing agreement (ISA), and successor custodian agreement.

For instance, when a patient attends a clinic, their details are nearly always entered into a computer software program to maintain demographic information, manage patient appointments, and to process payments. Often, health service providers (including physicians, pharmacists, chiropractors, dentists, psychiatrists and more) record their patients’ notes into an electronic medical record (EMR).

Patient information is shared between providers where required. For example, when the patient visits a diagnostic lab for testing, results are often transmitted electronically to the ordering physician’s fax machine or to the EMR.

Custodians including physicians, pharmacists, chiropractors, dentists, and psychiatrists, as defined by the Alberta’s Health Information Act (HIA), must follow HIA legislation when they collect, use, and disclose health information.

Often, custodians are also the owners of independent healthcare practices. However, an owner of a healthcare practice is not the custodian if they are not also an active member of a regulated health profession named as custodians in the HIA.  

1. Information Manager Agreement

The HIA allows custodians to contract with other health service providers and vendors for the purposes of providing information management or information technology services, so patients can receive health services, and make payments. This often requires the custodian to share patient information with a vendor (or give them access to) so the vendor can process, store, or provide information as needed.

The custodian selects one or more business to provide the services, equipment, or software to assist in the management of health information. For example: EMR provider, contracted transcriptionist, billing agent, remote backup service, etc. These businesses are known in the HIA as information managers.

Before sharing health information with someone else, the custodian must ensure that the partners and vendors have reasonable safeguards in place to protect sensitive health information. The custodians must ensure that there is a written agreement between the custodian and the information manager. These agreements are known as “Information Manager Agreements.” This requirement is stated in the HIA section 66(2).

The Information Manager Agreement (IMA) is one of three crucial agreements a healthcare practice must have in place.

If You Don’t Have an IMA

If you are a custodian who uses vendors as part of your business and you do not have an IMA with that vendor…

  • You are in breach of the HIA.
  • You may incur fines under the HIA.
  • You may face sanctions and disciplinary actions from your professional regulatory college.
  • Almost certainly, you will encounter conflicts, poor communication, between yourself and the vendor(s) and the other participating custodians in your practice.
  • You may lose control of the health information as reported in the Investigation Report H2013-IR-01from the Alberta Office of the Information and Privacy Commissioner (OIPC).

In a press release from the Alberta OIPC in 2013, Information and Privacy Commissioner Jill Clayton noted that:

“The HIA allows custodians to disclose health information to IT service providers, such as EMR vendors, under an appropriate Information Manager Agreement. When custodians do not sign these agreements, they may find themselves in the unfortunate position of losing control over the health information they need to provide health services.”

Investigation Report H2013-IR-01 (

Who Must Create the Information Manager Agreement?

The custodian is responsible to ensure that there is an appropriate IMA created and signed.

The information manager can assist the custodian by preparing templates of the IMA including specific details of the services that they will provide and the safeguards that the vendor will implement to protect personal health information.

Key Points About IMAs

A few important notes about IMAs.

  • IMA must be signed by the custodian.
  • Agreements signed by individuals who are not custodians are not valid under the HIA.
  • Custodians are required under the HIA to have an IMA with the vendor before disclosing health information. If there is no agreement in place, the custodian is in breach of the HIA.
  • Custodians are responsible for the health information that they collect, use, and disclose. Therefore, the custodian is responsible for the IMA and to ensure that the health information will be handled confidently and securely.

Key Points IMA

The custodian can select the best vendor and information manager for the job. The vendor who understands the requirements of the HIA and who can demonstrate that they have implemented the appropriate reasonable safeguards and can assist the custodian to develop an appropriate IMA is, in my opinion, demonstrating a significant competitive advantage.

All healthcare providers in a community practice should spend time when creating their business to establish good business practices, including developing written contracts and agreements to improve the efficiency of the business and to make things happen in the way that they are planned.

Here is a common example

Dr. Alice and Dr. Mark created a welcoming family medical practice in a new sub-division of their city. They each worked hard to attract new patients, hire and train staff, and develop a profitable business.

In the last few years, Alice and Mark had differences of opinion on how to grow their business. In the end, Alice decided that this type of practice wasn’t for her. She decided to leave and join a larger practice in a neighbouring subdivision. Alice wanted to take her patient’s records with her to her new practice and continue to see her patients at the new location.

Mark, who had signed the IMA with the EMR vendor, did not agree to Alice’s request to transfer her patient records to her new group practice.

Alice and Mark argued and eventually involved a professional mediator to help them resolve their business conflict. Hurt feelings between the providers and staff, costly delays in their business and expenses could have been avoided if Alice and Mark had established clear expectations in the event of the termination of their business partnership when they started their group practice. An IMA between custodians in a group practice is a recommended best practice.

When You Have Multiple Custodians in Your Healthcare Practice

When the practice has multiple providers, the owner and custodian frequently assumes responsibility for maintaining the contracts and IMAs with the vendors. Each of the participating healthcare providers may delegate the responsibility of maintaining the vendor arrangements to the custodian owner. This can be achieved with an IMA between the owner / custodian and each participating custodian.

Custodian Owner IMA

Each healthcare provider custodian is considered the custodian of the health information that they collect. The custodians can jointly agree to all use the same EMR. This provides continuity of care for the patients and economy of scale for the participants of the practice.

When the owner/custodian signs the agreement with the EMR, they become the signatory custodian. The EMR vendor takes their instructions from the signatory custodian.

The owner / custodian is now an information manager for all the participating custodians.  but does not become a custodian of the health information provided to them in their roles as an information manager.

For example,

Dr. Bill opened his medical practice, ABC Clinic. Later, additional physicians were recruited to work at ABC Clinic. The physicians are each custodians as defined by the HIA.

Dr. Bill assumes the responsibility for the operations of the clinic including the computer network and the contract with the EMR vendor. Dr. Bill is the information manager for the patient records at the clinic.

Each physician signs an IMA with Dr. Bill and agree that he will continue to manage the patient records on their behalf. Dr. Bill is operating as an information manager.

In his role of the information manager, Dr. Bill must follow the instructions from each physician, the custodian, as it relates to the management of their patients’ records.

2. Information Sharing Agreement (ISA)

When you have more than one physician in your practice, you need an agreement about how you will decide to manage the personal health information in your practice.

An Information Sharing Agreement (ISA) focuses on the internal decision making about all things related to personal health information whereas, an IMA is an agreement with a single vendor about the services that the vendor provides.


An ISA may include things related to the services that a vendor provides but is not limited to just vendor services.

It also includes decisions about the process to ensure appropriate role based access to personal health information in the EMR, computer network, and paper formats; the regular review of health information privacy and security policies and procedures, ensuring privacy and security awareness training, the regular review of administrative, technical, and physical safeguards in the practice, and so on.

In larger organizations or when several smaller organizations participate in an information sharing initiative, a Data Management Committee may provide oversight and facilitate this process.

An ISA is a requirement of the College of Physicians and Surgeons of Alberta.

Identifying a successor custodian is also a requirement of the College of Physicians and Surgeons (CPSA).

3. Successor Custodianship Agreement

As a business owner, you need to plan a successor to the business. This might be an interim or short-term decision to ensure continuity during an absence or future retirement planning or unexpected illness or death.

In healthcare, physicians and custodians have the added responsibility as the ‘gatekeeper’ for patient records. In the event of a sudden inability to meet these responsibilities, physicians need to identify a successor custodian to ensure appropriate and continued access by patients to their health information for their continuing care and treatment and to ensure that the continuing confidentiality, security, and access to patient records continue to be fulfilled.

Have you identified a successor custodian? Each of the physicians in your group practice should also identify their own successor custodian.

This is a CPSA requirement and should also be included in the Privacy Impact Assessment if you have this information available. See CPSA, Patient Record Retention, s.5:

A regulated member acting as a custodian must designate a successor custodian to ensure the retention and accessibility of patient records in the event the regulated member is unable to continue as custodian. (Reference: Health Information Act Section 35(1)(q)

If you are a chiropractor, the Alberta College and Association of Chiropractors (ACAC) further requires its members to name a chiropractor as the successor custodian to maintain the status of ‘chiropractic’ records. (See the ACAC’s Standards of Practice s5.3 Custodianship of Health Records.)

A chiropractor, as a custodian of health records, is responsible for the care and control of the health records in their practices as required by the Health Information Act of Alberta. A custodian of active chiropractic files must be under the custody or control of an active, registered member of the ACAC.

Note that under the Health Information Act, a chiropractor may disclose files to another custodian who is not a chiropractor, and only a chiropractor may have custody or control of chiropractic files. Chiropractic files disclosed to a non-chiropractor should no longer be considered chiropractic files.

A custodian must implement technical and physical safeguards to protect the confidentiality of the information and privacy of individuals as well as protections against reasonably anticipated threats to the security or integrity of the information. A custodian must also defend against unauthorized uses, disclosures or modifications of the information. Safeguards must be periodically assessed and documented in policies and procedures.

If you are working in an owner/custodian scenario discussed above, clearly identifying a successor custodian becomes imperative. An unplanned absence of the owner / custodian can seriously jeopardize the business and the continuing care and treatment of patients.

The custodian can, but is not required to, name another custodian in the same practice to be their successor. Whatever your decision, ensure that this is well documented and easily accessible to the other custodians and key decision makers in your organization in the event of an emergency.

The best time to create IMA, ISA, and Successor Custodianship Agreements is when you start your healthcare business.

The second best time in now.

What are you waiting for?

If you need assistance, contact Jean L. Eaton, Your Practical Privacy Coach and Practice Management Mentor with Information Managers. I’m here to help you with your Practice Management Success.

If you are a member of Practice Management Success, login here to access the Top 3 Agreements.

When we know better, we can do better…

Jean L. Eaton is constructively obsessive about privacy, confidentiality, and security especially when it comes to the handling of personal health information. If you would like to discuss how I can help your practice, just send me an email. I am here to help you.

Jean L. Eaton
Your Practical Privacy Coach

Protect Your Practice, Your Assets, and Your Patients with Privacy Impact Assessments – A Complete Step-by-Step Course

Protect Your Practice, Your Assets, and Your Patients with Privacy Impact Assessments – A Complete Step-by-Step Course

Do you need a Privacy Impact Assessment?

Or do you need to amend an existing PIA?

Privacy Impact Assessments are just one of the requirements you need in order to fulfill your obligations in Alberta’s Health Information Act (HIA) and other legislation and are an important aspect of developing privacy best practices in your office.

And a little help along the way is always a good thing.

Practical Privacy Coach, Jean  L. Eaton of Information Managers, is constructively obsessive about privacy, confidentiality, and security when it comes to the handling of personal and health information, particularly in primary health care settings. Jean has helped hundreds of healthcare providers, vendors, and health and social service delivery organizations and associations complete their Privacy Impact Assessment which have been successfully accepted by organizations’ management and regulators. Jean has customized and delivered privacy training programs for privacy officers, records management professionals, implementation teams, and healthcare providers across Canada and the US.

Now you can have access to five modules to help you learn everything you need in order to complete your own PIA.

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**** New PIA Amendment Track ****

Each module includes a video training, as well as templatestoolsresources and case studies to build on in each lesson. You can use this scenario to guide you through the PIA process in healthcare. If you work in healthcare or privacy or records management and need to do a PIA, this e-course is for you.


You need a Privacy Impact Assessment (PIA) when

  • You  are opening a new clinic or establishing a new health services program.
  • You are changing administrative procedures or technology equipment, services, or vendors
  • You are changing how you collect and use personal information,
  • You are implementing or changing an Electronic Medical Records (EMR)
  • You are sharing health information with another healthcare provider, organization, Primary Care Network or other health program.
  • You want to prevent a privacy breach,
  • You have a Privacy Impact Assessment that was written more than 2 years ago (It is time to review and update this!)


If you are a healthcare provider, practice manager, and you need your first Privacy Impact Assessment, this e-course is for you

Are you in a group or solo practice with direct patient care, for example:

  • Physician
  • Pharmacist
  • Registered nurse
  • Optometrist or optician
  • Chiropractor
  • Physiotherapist
  • Midwife
  • Podiatrist
  • Dentist, dental hygienist or denturist
  • Audiologist
  • Mental health practicitioner
  • Laboratory, x-ray, and imaging technician
  • Paramedic

A PIA should be as common place to a healthcare practice as a business plan is to a business. BUT most healthcare practices don’t know this and often don’t know that a PIA is  usually part of their professional college requirements and often even a legislated requirement! Prevent malicious errors, omissions or attacks that could result in fines and even jail time for the business, healthcare provider, employee, or vendor by completing a PIA.

If your Privacy Impact Assessment was written more than 2 years ago this online on-demand course is for you!

The Clinic Manager and Physician Lead and Privacy Officer  must ensure its content is updated to reflect the current state of administrative, physical and technical controls.

BONUS! Checklist to update your PIA to meet recent changes to Alberta’s Netcare Portal. If your practice has completed a PIA and now you need to update the PIA, you receive a checklist of items that you need to consider to refresh your PIA.


If you are vendor that supports healthcare practices this e-course is for you!

BONUS! One hour tele-consult with Jean, “Create a branded Privacy Impact Assessment Readiness Package”. Jean will work individually with you to review your documentation and coach you on how to prepare the package to give to healthcare practices.

BONUS! Vendor PIA live webinar includes Vendor non-disclosure agreement, Information Manager Agreement, GAP Analysis, Computer Network Narrative templates.


Jean has helped hundreds of physicians, chiropractors, pharmacists, and other healthcare providers complete their Privacy Impact Assessment. She has visited hundreds of practices across Canada. But time and geography limit my ability to visit each healthcare practice that needs a PIA. That’s why I developed this on-line interactive course to help you learn everything you need in order to review, amend, or create your own PIA. Each module includes a video training as well as templates, tools, resources and two common case studies to build on each week. You can use these scenarios to guide you through the PIA process.

You know your practice better than anybody else. If you had the right tools, at the time most convenient for you and a mentor to help you, you can develop good office practices, meet legislated and college requirements, and successfully complete your Privacy Impact Assessment requirements.

Using a Webinar on-line interactive program, you will get great content and mentoring from Jean Eaton and once a month during the Q&A live training webinars. Learn the PIA process with these modules.

The modules include:

Module 1:

PIA to Protect Your Practice, Your Assets, and Your Patients


Module 2:

Information Flows–-the Foundation of Your PIA


Module 3:

Risk Analysis and Mitigation Strategies


Module 4:

PIA Format – Pulling it All Together


Module 5:

Complete Your PIA Submission

BONUS Module 6:

Create a Branded Privacy Impact Assessment Readiness Package

The replays, tools, and resources will be available to you right away.

If you are new to this field, I suggest that you first register for Privacy Awareness in Healthcare: Essentials to master the key definitions and concepts.

Corridor Interactive


Protect Your Practice, Your Assets, and Your Patients with Privacy Impact Assessments –

A Complete Step-by-Step Course

5 Core Modules, Templates, Training, and Tools to Get Your PIA Done!

Monthly Live Q&A Training Webinars

$450.00 (plus GST)

Purchase e-course


You will get

  • Learning Resource Guide for EACH module – how-to explanations, templates, and resource lists
  • Checklists to help you plan your PIA
  • MindMap of the entire PIA process
  • PIA project plan timeline templates
  • Checklists of  personal and health information privacy and security policies that you need in your practice
  • Many examples of projects in medical, dental, chiropractic and more practices including new PIA project and PIA amendments.
  • Explanation and real-life examples of key terms that you need to know and include in your PIA
  • Strategies and templates of risk management assessments that you can customize
  • This E-course might qualify for CPE credits, too!


BONUS!  Monthly live Q&A webinar training with Jean to help you get un-stuck with your PIA.

BONUS! Checklist to update your PIA to meet recent changes to Alberta’s Netcare Portal.

BONUS! Private discussion group with other registered participants of this course to network and support each other on your PIA journey and continue to help you after this course closes.

BONUS! Regular updates of privacy resources and templates that you can use.


If you hired a consultant to do the work of the PIA process for you it may cost you as much as $3,000!

And then…when the consultant is done, they take their knowledge out the door with them.

Invest only $450 in this course and you’ll have what you need to do your first PIA project today…and every project in the future!

Jean Introduction Ecourse PIA (1)

I had the pleasure of working alongside Jean to develop a PIA for my Dental Office. I could not have completed this document without her. She was there to help me every step of the way. Her online course made it easy to communicate with her as well as having so many resources to use that were so helpful. Each Module had videos to watch that explained step by step what needed to be done. The PIA document is a lot of information to put together and if it’s not enough information on its own, you also need to develop a policy and procedures manual. Jean has developed an amazing resource for this manual that was very user friendly and made a 300 page manual a lot more attainable than creating it on your own. I highly recommend taking Jean’s PIA course and having her help throughout the process!”

~~Lindsey Cave, Office Manager, Orion Dental Group


What people are saying about our PIA e-courses and in-person workshops:

Q: What did you learn from this workshop?

Participant’s Responses:

  • Understanding of need / use of Information Management Agreement’s and an ‘Evaluation” agreement.
  • Lots – when / how to make amendments.
  • Compliance / requirements of PIA and their purpose.
  • PIA information; agreements, updating.


Q: What do you feel was the biggest benefit to attending this workshop?

Participant’s Responses:

  • Understanding a PIA.
  • Having a better understanding of PIA’s and everything included in requirements.
  • Gain a better overview of my PIA and what I need to add; organizational strategy.
  • Clear vision of work to be done.

“When Jean told us about the Protest Your Practice, Your Assets, and Your Patients with Privacy Impact Assessments E-course and explained how the course will help us better understand the Health Information Act, our responsibilities as healthcare providers and our relationship with our vendors and partners, I signed up right away! Thanks again – it is no doubt that we have hitched our wagon to a shining star.”
~~Bill Stowe, Business Manager Synergy Respiratory & Cardiac Care

“This was my first ever time I had to work on a PIA and I was a little nervous about doing it efficiently – but you really made it as simple and straight forward as possible. Thank you for being available for my questions when I had them. I would easily recommend Privacy Impact Assessments to Protect Your Practice course for anyone to do their own PIA’s! Thank you so much!”
~~Karen Sarabura, Clinic Manager and Privacy Officer, CGA Medical Imaging, Alberta

“I attended the Privacy Impact Assessment Walk-through workshop (for ARMA members). Jean shared resources and on-going networking opportunities. The biggest benefit to me is to know that there is help out there in moving forward with our Privacy Impact Assessment responsibilities.”
~~Ellen Sauvé, Parkland County

Comments from other E-course participants:

“Learning about how all the information gathering systems interact was the most valuable part of this workshop”

“Excellent presenter – variety of learning opportunities.”

“Jean is an excellent speaker and I enjoyed the audio seminar you gave today and I learned a lot from your seminar.”
~~Annette T (AHIMA webinar, Three Mistakes in Managing a Privacy Breach”)

“Jean Eaton is one of those ‘critical suppliers’ you keep in your email contacts list, no matter what company you manage. She really knows her stuff and delivers prompt, accurate information on time. Her courses are interesting, informative, and I like the opportunity to meet with classmates who have similar challenges.”
~~Kevin Morris, Shape MD, Team Leader/Office Manager


Buy e-course

In-Person Workshops Are Now Available

Are you a hands-on kinda person?

Are you more likely to get things done when you schedule your time for a working meeting?

Would you like help to kick-start your PIA amendment and review with other like-minded clinic managers and privacy officers?

PIA Amendment Workshops are available. Send a request to me and let’s set up a workshop near you! You also get full access to the on-line course to support you after the workshop.



Not sure if the E-course is for you?

Jean will answer your questions in the free webinar,


Prevent Big Fines (or Worse!) for Your Healthcare Practice

How to Plan a Privacy Impact Assessment for Your Healthcare Practice

with Jean L. Eaton
Replay Recorded Live

This webinar is for Privacy Officers, Clinic Managers, Practice Managers and anyone else responsible for doing a PIA.

You will learn what is getting in your way of getting your PIA done!

In this free webinar, you will learn:

  • 5 Manageable Steps of every PIA
  • 3 Biggest Myths about PIA’s that is preventing you from completing your PIA
  • Questions Privacy Officers, Clinic Managers, Practice Managers and Healthcare providers should ask about PIA’s but don’t
  • Biggest fears about doing a PIA and how you can kick it to the curb so that you can finally get it done

Join us for the webinar so that you can plan your PIA for your healthcare practice!

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 Along with your webinar registration, you will also benefit from the occasional Privacy Nugget tips by email of similar privacy resources and articles that you can use right away!