■ Safety of care:
Improving patient safety and reducing risks
Providing virtual care during the COVID-19 pandemic
COVID-19: Virtual care (19 min)
Published: June 2020; revised March 2021
The information in this article was correct at the time of publishing
- Many regulatory, public health, and government authorities encourage virtual care—via telephone, video platforms, and so on—as an alternative to face-to-face visits in an effort to limit direct contact as part of the COVID-19 response.
- Making use of virtual care for some patients as a way to decrease transmission of COVID-19 should be weighed against the need to see and examine patients in person. Maintaining this fine balance can be challenging for health practitioners.
- While facilitating efficient and safe patient care, professional and regulatory requirements continue to be important for guiding the appropriate use of virtual care.
The bottom line
- Virtual care can be an effective way of delivering patient care during the COVID-19 pandemic.
- Use professional judgment when assessing if, when, and how to use virtual care. Many regulatory authorities (Colleges) offer guidance on how to provide care in the current context. Contact the CMPA for advice on managing the risks associated with using virtual care.
- Be mindful of the limitations of virtual care and ensure patients are provided the opportunity for in-person care, where appropriate and available.
- Document consent from patients to use virtual care. Privacy obligations and the duty of confidentiality continue when using virtual care, even in a public health emergency such as COVID-19.
Need to know
- Virtual care is not a substitute for in-person assessments or clinical examinations, where required, or for attending the emergency department when needed for any urgent care.
- Guidelines identify potential medical problems that can be safely assessed and treated, including the Canadian Medical Association’s Virtual Care Playbook [PDF]. College policies and standards should also be considered.
Privacy and confidentiality
- Make best efforts to protect patients’ privacy in the provision of virtual care. Consider confirming the identity of the person you are interacting with at the beginning of the encounter, disabling options to record the encounter, and encouraging people to participate in a private setting.
- Some Colleges impose or recommend consent requirements when using virtual care. Obtain consent from the patient following a discussion of the potential privacy risks associated with electronic communications. While it may not always be possible to obtain a signed consent form, a record of the consent discussion can always be included in the patient’s chart.
- Use your professional judgment to determine which virtual care tools to use and how. While some Colleges and health authorities set out specific virtual care products to be used, many do not. Resources are available to assist physicians in deciding on an appropriate platform (e.g. Doctors of BC Virtual Care Toolkit [PDF]) and which may be helpful when considering security and privacy safeguards used by different virtual care products, among other features.
- Before providing virtual care to patients in another province or territory, consider whether you have complied with applicable telemedicine licensing requirements.
- While some Colleges allow for increased flexibility during the COVID-19 pandemic, licensing requirements vary between jurisdictions. For example, the College of Physicians and Surgeons of Nova Scotia permits physicians licensed in Canada to deliver telemedicine services to patients in Nova Scotia, unless specifically restricted from doing so by their home licensing body. Other Colleges require special registration and may place conditions on the provision of such services.
Eligibility for CMPA assistance
- CMPA members are generally eligible for assistance with matters arising out of virtual care where the medical-legal problem or legal action is initiated in Canada.
- Members who are located outside of Canada on a more permanent basis are at greater risk of being sued in that foreign jurisdiction. Where a member is residing outside of Canada on a long-term basis and providing telehealth to patients in Canada, the member will not generally be eligible for assistance.
- If you are contemplating providing virtual care to patients outside of Canada, contact the CMPA in advance.
- The COVID-19 pandemic has resulted in the broader implementation and use of virtual care on short notice. Many of the changes implemented to permit virtual care during the pandemic are likely to continue afterwards.
- Practical guidance continues to be developed for physicians regarding appropriate clinical practices for virtual care and appropriate tools and procedures to maintain privacy.
- As virtual care develops, it will continue to be important for health practitioners to keep current with the new and evolving medical-legal issues.