Principles of assistance
Originally published March 2006 / Reviewed September 2013
The following outlines the CMPA's principles of assistance for members whose practice includes telehealth. The CMPA considers "telehealth" to include any technology that enables the delivery of care at a distance.
Eligibility for 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 members in the event of medical-legal difficulties arising in Canada as a result of professional work done in Canada. The CMPA is not structured to assist with medical-legal problems and legal actions that arise outside of Canada or that result from care given outside of Canada.
When patients or physicians, or both, are temporarily outside of Canada, issues concerning continuity of care and physician obligations may arise. The CMPA recognizes such challenges and the benefits of using telehealth technologies to bridge or mitigate interruptions in healthcare delivery. Under such circumstances, members would generally be eligible for CMPA assistance, provided the medical-legal problem or legal action is initiated in Canada.
- 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 medical-legal problem or legal action is initiated in Canada, the member is generally eligible for CMPA assistance.
- Patient and/or member temporarily outside Canada
A telehealth encounter occurs between a patient and a CMPA member, both of whom are ordinarily residents of Canada. At the time of the encounter, the patient or the member, or both, are temporarily located outside of Canada. If the medical-legal problem or legal action is initiated in Canada, the member is generally eligible for CMPA assistance.
- Patient residing outside Canada
A telehealth encounter occurs between a patient residing 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 initiated in Canada or elsewhere.
If a patient is outside of Canada temporarily (e.g. on vacation, temporary employment, or students pursuing studies abroad) and phones or emails the physician's office regarding a medical problem related to a condition the physician is managing, the member 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 advising the patient to seek local follow-up.
Before providing a telehealth service, consider 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 to the CMPA and are you paying the appropriate membership fee?
- If you live outside Canada, do you have professional liability insurance for medical-legal problems and legal actions brought outside of Canada?
- Have you communicated to your patients the conditions of your availability when either they or you are temporarily absent?
Other CMPA principles of assistance may affect eligibility for assistance in telehealth encounters
- Is the patient ordinarily a resident of Canada? If the patient is a non-resident, refer to the CMPA's principles of assistance when treating non-residents of Canada. In particular you should make reasonable attempts to have the patient sign the Governing Law and Jurisdiction Agreement.
- Is your telehealth practice in a clinic or facility? You should be familiar with the CMPA's principles of assistance described in Assistance to clinics and facilities.