Advanced search

PDF version

CMPA assistance in legal matters arising from telehealth: Technology makes location of physician less relevant
An article for physicians by physicians
Originally published March 2006 / Revised August 2008, March 2009
IS0661-E

Of interest to all physicians

Member interest and participation in telehealth continue to grow. Technology now enables some physicians to care for their patients in Canada, even when the physician is outside of Canada.

Most radiological diagnostic images taken in Canada are generated digitally. Teleradiology makes it possible for images to be viewed elsewhere in the world without loss of quality.

The rapidly evolving practice of telehealth has made the location of the physician less relevant. To reflect this change, the CMPA has updated its general principles on the extent of assistance available for medico-legal difficulties arising from the practice of telehealth.

Approach to assistance

The CMPA's approach to assisting members with matters related to telehealth is consistent with its approach to assisting members in other matters: the CMPA will generally assist its members in the event of medico-legal difficulties arising in Canada as a result of professional work done in Canada. The CMPA is not structured to assist with problems that arise outside of Canada or result from care given outside of Canada. Legal actions in other jurisdictions, particularly the United States, can be prohibitively expensive.

In determining your eligibility for CMPA assistance in the practice of telehealth, an important factor is where the professional work is done or, in other words, where the care is provided. The CMPA deems the location where care is provided to be where the patient is located at the time of the telehealth encounter. Technology has made the location of the physician less relevant.

Deciding on eligibility

In general, members will be eligible for CMPA assistance with matters arising from a telehealth encounter when:

1. The patient was in Canada at the time of the encounter, and
2. The member was either in or outside Canada at the time of the encounter.

Furthermore, the CMPA generally will not assist in matters arising from a telehealth encounter where the patient was outside of Canada at the time of the encounter.

Assistance scenarios

1. Patient and member in Canada
   A telehealth encounter occurs between a patient ordinarily resident in Canada and a CMPA member. The patient and the member are in Canada at the time of the encounter, although they may not necessarily be in the same province/territory. If the legal action is brought in Canada, the member is generally eligible for CMPA assistance.
2. Patient in Canada and member outside Canada
   A telehealth encounter occurs between a patient ordinarily resident in Canada and a CMPA member. At the time of the encounter, the patient is located in Canada and the CMPA member is located outside of Canada. If the legal action is brought in Canada, the member is generally eligible for CMPA assistance.
3. Patient outside Canada
   A telehealth encounter occurs between a patient located outside of Canada and a CMPA member located either in or outside Canada. In this scenario, the CMPA will generally not assist regardless of whether the legal action was brought in Canada or elsewhere.

Other scenarios may occur, such as when a patient is outside of Canada temporarily (e.g., on vacation, temporary employment, or students pursuing studies abroad) and phones or emails your office regarding a medical problem related to a condition you are managing. In such a situation, you would generally be eligible for assistance, as long as any legal action is initiated in Canada. Given the potential limitations of such communication, it may be prudent to consider the appropriateness of advising the patient to seek local follow-up.

Before becoming involved in a telehealth encounter, check the following:

• Have you complied with all applicable licensing requirements in the jurisdictions involved in the telehealth encounter? To ensure you are aware of applicable licensing requirements, consult your provincial/territorial regulatory authority (College). If you and the patient are located in different jurisdictions, you should also inquire with the College in the jurisdiction where the patient is located.
• Do you meet all applicable credentialing requirements established by the hospitals or clinics involved in the telehealth encounter?
• Do you meet all applicable technological standards established by the appropriate organizations?
• If the telehealth encounter is outside your province of work, have you indicated the proper province of work (POW) to the CMPA and are you paying the proper fee?
• If you live outside Canada, do you have professional liability insurance for legal actions brought outside of Canada?

Be aware other CMPA general principles may affect your eligibility for assistance in telehealth encounters:

• Is the patient ordinarily a resident of Canada? If the patient is a non-resident, please refer to the principles on assistance in legal matters initiated by non-residents. In particular you should make reasonable attempts to have the non-resident sign the Governing Law and Jurisdiction Agreement.
• Is your telehealth practice in a clinic or facility? You should be familiar with the concepts described in the article CMPA assistance to clinics and facilities: general principles.