■ Safety of care:
Improving patient safety and reducing risks
Providing virtual care during the COVID-19 pandemic
Published: June 2020
Revised: March 2023
The information in this article was correct at the time of publishing
COVID-19: Virtual care (19 min)
- The CMPA considers "virtual care" to include any care provided when the physician and their patient are not physically together in the same room, including video and phone consultations and discussions.
- Virtual care was promoted as a method of delivering care during the early stages of the pandemic. However, many regulatory, public health, and government authorities now expect physicians to see patients primarily in-person given high vaccination rates and more readily available personal protective equipment.
- While virtual care remains beneficial to support access to care, physicians will want to be mindful of its limitations. The general expectation is that physicians are to meet the standard of care, even where care is delivered virtually.
- 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.
- Use professional judgment when assessing if, when, and how to use virtual care. Many regulatory authorities (Colleges) offer guidance on when it is reasonable to rely on virtual care. 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 seen in person where necessary to meet the standard of care.
- 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 patient you are interacting with at the beginning of the encounter, disabling options to record the encounter, and encouraging patients 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 licensing requirements.
- While some Colleges allowed 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 elsewhere in Canada to deliver virtual care to patients in Nova Scotia but they remain subject to the regulation of 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 a virtual care encounter between a patient ordinarily resident in Canada and a CMPA member, where the patient and member are located in Canada at the time of the encounter and where the medico-legal problem or legal action is initiated in Canada.
- Where the patient or the member, or both, are temporarily located outside of Canada at the time of the virtual care encounter, the CMPA will consider providing assistance with a medico-legal problem or legal action in Canada, arising from urgent follow-up care to an existing patient.
- 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 virtual care to patients in Canada, the member will not generally be eligible for assistance.
- The COVID-19 pandemic has resulted in broader implementation and use of virtual care. Many of the changes implemented to permit virtual care during the pandemic are likely to continue afterwards.
- Practical and regulatory 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 progresses, it will continue to be important for physicians to keep current with the new and evolving medico-legal issues.