DATA SHARING AGREEMENT THIS AGREEMENT dated as of the day of , 20 . BETWEEN: (the “Provider”) - and - THE UNIVERSITY OF MANITOBA MANITOBA CENTRE FOR HEALTH POLICY (“MCHP”) WHEREAS this constitutes an agreement of the conditions under which de-identified electronic data from the Provider (the “Data”) will be disclosed to MCHP in accordance with the provisions stated in The Personal Health Information Act (Manitoba), The Freedom of Information and Protection of Privacy Act (Manitoba) and all other applicable federal and provincial legislative acts governing the use of the Data. THE PROVIDER AND MCHP AGREE AS FOLLOWS: 1. For this Agreement, the Data is described as the electronic records included in the located at . 2. As a trustee of the Data collected during the course of administering its services, the Provider agrees: 3. database a) to undertake a process of de-identifying the Data prior to any transfer of the Data to MCHP by using a process established by MCHP, in conjunction with Manitoba Health, to enhance the protection of privacy of individuals and/or organizations; b) to provide a de-identified copy of the Data to MCHP on an ongoing basis for the purpose of facilitating delivery, evaluation or monitoring of a program; research and planning that relates to the provision of health care; or academic research focusing on understanding the broader determinants of health; and c) to assume any costs it has incurred or will incur, in compiling and providing the Data. By accepting the Data, MCHP recognizes, acknowledges and agrees that research using the Data is permitted if: a) it is for statistical or research purposes including analyzing the health status of the population, identifying and describing patterns of illness, describing and analyzing how health services are used, analyzing the availability and adequacy of human resources required to provide health services, measuring health system performance, health system -2- planning, and undertaking academic research focusing on understanding the broader determinants of health; b) it is in the public interest; and c) the results remain in the public domain. 4. Access to the Data is provided for approved research projects that will be aimed primarily at establishing facts, principles or generalizable knowledge, which are of social value and intended to be publicly disseminated. 5. The Data shall not be released to any other person, group or organization without the prior written consent of the Provider. 6. MCHP has established, and will abide by, policies and procedures to ensure security, confidentiality and protection of privacy of the Data in accordance with The Personal Health Information Act (Manitoba), The Freedom of Information and Protection of Privacy Act (Manitoba) and all other legislative acts governing the use of this Data. 7. Access by researchers to the Data will only be permitted upon approval of the specific project (for which access to the Data is requested) by the Provider or their appointee, the University of Manitoba’s Health Research Ethics Board (HREB), and, where applicable, the Provincial Health Information Privacy Committee (HIPC). 8. Nothing in this Agreement shall prevent the following uses of any information, data (including data in tabular form), analyses and research acquired, developed or discovered upon the completion of an approved project: a) publication in learned journals or other printed media; b) oral presentation or the distribution of printed materials at educational or professional conferences or seminars; or c) publication of a thesis by a graduate student; provided that: 9. d) such publication or use shall not disclose any Confidential Information; e) such publication or use shall not disclose any Personal Information (as defined in The Freedom of Information and Protection of Privacy Act) or Personal Health Information (as defined in The Personal Health Information Act) respecting a third party in a way that could reasonably be expected to identify the third party, without the consent of that third party. As used herein “Confidential Information” means any and all information disclosed by the Provider which is identified in writing as confidential by the Provider. Confidential Information shall not include information that is: a) already known prior to receipt from the Provider as evidenced by written records; or -3- b) generally available to the public or becomes publicly known through no fault of the researcher; or c) received by the researcher from a third party who had a legal right to disclose without restriction; or d) developed independently of and without reference to the Confidential Information as evidenced by written records. Notwithstanding any other provision of this Agreement, disclosure of Confidential Information shall not be precluded if such disclosure is in response to a valid court order of any governmental agency, court or other quasi-judicial or regulatory body of competent jurisdiction, provided however, that MCHP, as promptly as reasonably possible, gives notice to the Provider of the requirement to disclose. 10. MCHP, and any employees of MCHP or persons involved with research, shall treat as confidential, and shall not disclose or permit to be disclosed to any person, corporation or organization, any Confidential Information provided by the Provider under this Agreement without prior consent of the Provider, whose consent shall not be unreasonably withheld. 11. The Provider will be informed of, and will be provided with, a copy of any publication, presentation or media interaction which has used the Data prior to its public release, however, the Provider has no right of censorship. 12. The Provider will be acknowledged in any report, publication, paper or presentation that uses the Data, and it shall be stated in such publication what Data was used as well as “that the results and conclusions are those of the authors and no official endorsement by the Provider is intended or should be inferred”. The Provider will be given one copy of any paper or report produced using the Data once the paper or report has been published. 13. The Provider may carry out such inspections, investigations or audits respecting MCHP’s information and privacy practices, policies, procedures and security arrangements as they consider necessary to ensure that MCHP is complying with the terms and conditions of this Agreement and that the Provider’s Data in the repository is adequately protected, provided that such inspections, investigations or audits are conducted during regular business hours and upon reasonable notice to MCHP. MCHP will cooperate in the inspection, investigation or audit, and will permit the Provider and its representatives access, at all reasonable times, to its premises and equipment (including computer equipment) and to records and information relating to MCHP’s information or privacy practices, policies, procedures or security arrangements or to this Agreement for these purposes. 14. If any review, inspection, investigation or audit identifies deficiencies in MCHP’s information or privacy practices, policies, procedures or security arrangements, MCHP will take immediate steps to correct the deficiencies and will promptly notify the Provider in writing as to the steps taken. 15. Where this Agreement is terminated for any reason by either party, MCHP shall furnish to the Provider, for its approval, a written plan detailing the procedures by which MCHP proposes to return to the Provider or dispose of or transfer to an “information manager” or “trustee” (within the meaning given to these terms under The Personal Health Information Act), all Personal Information (Data) received from the Provider that MCHP may hold as of the date of termination. In any event of termination, the parties agree to cooperate to ensure that any projects, papers, or -4- publications then in progress (on the date of termination) shall be allowed to proceed until completion or publication (in the case of a manuscript). 16. The governing law of this Agreement shall be that of Manitoba, or Canada, as the case may be. The parties irrevocably attorn to the jurisdiction of the Courts of Manitoba (Winnipeg Centre). 17. This Agreement may be executed in any number of counterparts and by different parties in separate counterparts, each of which when so executed shall be deemed to be an original and all of which taken together shall constitute one and the same agreement. Delivery by facsimile or by electronic transmission in portable document format (PDF) of an executed counterpart of this Agreement is as effective as delivery of an originally executed counterpart of this Agreement. THIS AGREEMENT has been executed on behalf of the Provider by its duly authorized representative and on behalf of MCHP by its duly authorized representative, as of the date first written above. Per: Witness Name: Title: THE UNIVERSITY OF MANITOBA Per: Witness Dean, Faculty of Medicine H:\Legal\LEGAL OFFICE\Precedents\Website Documents\Signing Policy\Data Sharing Agmt (MCHP) - May 2010.Doc