Virtual Care
A Standard of Practice is the minimum standard of professional behaviour and ethical conduct expected by the College of its registrants, on a specific issue.
Preamble
Evolving technology provides opportunities for new approaches to the practice of Medicine through virtual care. The College of Physicians and Surgeons of PEI recognize the value of virtual care to improve access to care and increase efficiencies in the delivery of care. This standard of practice sets out the College’s expectations of registrants who provide virtual care.
Definition
Virtual Care is an interaction between patient and registrant, occurring remotely, using communication/information technologies (telephone, email, text, video, remote monitoring, etc.) with the goal of facilitating or maximizing the quality and effectiveness of patient care.
Appropriate use of Virtual Care
Virtual Care is most appropriately used when integrated with comprehensive longitudinal primary care. In the context of episodic care, access to in-person care must be provided as needed and may require formal affiliation with in-person providers where the patient resides. The use of virtual care does not alter the ethical, professional and legal obligations of registrants.
Standard of Practice
A registrant practicing virtual care is held to the same standard of legal, ethical, competent, and professional care as a registrant providing personal face to face medical services. The standard of care provided by registrants to patients remains unchanged, whether in-person, via telephone, video or other means. The registrant must satisfy the requirements for registration under the Regulated Health Professions Act and Medical Practitioners Regulations and hold an unrestricted independent license.
When practicing virtual care, a registrant must:
- Consider the patient’s existing health status, healthcare needs and circumstances, and only provide virtual care if it is in the patient’s best interest.
- Identify what resources (technology, equipment, support staff, etc.) are required, and only proceed if those resources are available and can be used effectively.
- Ensure that the registrant’s identity, location, and licensure status is known to the patient.
- Take reasonable steps to ensure that all medical information is transmitted in a manner which protects the privacy and confidentiality of the patient and their personal health information.
- Ensure the physical setting in which the medical care is being delivered is appropriate and safe and that a plan is in place to manage adverse events and /or emergencies.
- Maintain medical records, communicate with referring or other treating care providers, arrange follow-up as would be expected with an in-person encounter.
- Regarding prescribing narcotics or other controlled/regulated medications, it is ideal that the virtual care registrant has a longitudinal relationship with the patient or has been in communication with another licensed healthcare provider who has reviewed the patient and has an established therapeutic relationship. If the above is not possible, a virtual care registrant may prescribe narcotics or controlled/regulated medications, if their clinical assessment suggests it would be in the best interest of the patient to do so.
If the above requirements cannot be met, a registrant should not proceed with providing virtual care. In circumstances where virtual care is not appropriate, registrants have a professional and ethical obligation to not abandon patients for whom they have accepted professional responsibility.
Registration
The College will not be issuing licenses specifically for virtual care or telemedicine.
The College regulates the practice of medicine by registrants registered in PEI. At this time, the College considers the practice of medicine to be when a registrant provides care to a patient who resides in PEI. Different to some other jurisdictions where practicing medicine is based on the registrant’s location, in PEI it is where the patient is located. As such, any registrant who provides virtual care to a PEI patient must be registered in PEI and adhere to the College’s Standards and Policies.
Exceptions to the requirement of registration in PEI would include registrants who:
- Have been consulted or are working in collaboration with a registered Island physician/Nurse Practitioner.
- Are providing virtual care for emergency situations.
- Are providing follow-up of a previously assessed patient.
- Are providing off-Island test interpretation, (examples would be EEG’s, pathology, etc.).
- Work with Poison Control.
- Work as a consultant in Genetics.
- Are seeing federal employees as per a national program and are fully registered with a different jurisdiction within Canada
All registrants must hold professional liability coverage which includes the provision of virtual care to PEI patients.
Referring Patients for Out-of-Province Virtual Care
Before consulting with or referring patients out of province for care, registrants must take reasonable steps to assure themselves that the consultation or referral is appropriate and the out of province registrant is licensed by the regulatory body in their place of residence.
Registrants should inform their patients that the registrant is not physically located within the province and inform them of the regulatory body which has licensed the registrant.
Providing Virtual Care to Patients Outside of PEI
Registrants who are registered to practice medicine in PEI and wish to provide virtual care to a patient in another province or territory must comply with the requirements of that jurisdiction and the requirements of PEI. The College recommends the registrant contact the regulatory College in the jurisdiction where the intended patient is located to obtain information about registration requirements. The College also recommends contacting the malpractice insurance provider to ensure they are covered to provide virtual care.
Complaints
The College will only investigate complaints made about registrants who are registered in PEI, regardless of the location of the patient.
The College will not investigate complaints made about a registrant who is not registered in PEI but will share any complaint information brought to our attention with the regulatory authority that has jurisdiction over the registrant.
Document History
Approval Date: October 10, 2023