In December 2014, The College of Physicians and Surgeons of Ontario (CPSO) reviewed and updated their Telemedicine policy, providing clarity on general expectations for telemedicine and specific expectations for practicing telemedicine across borders. I had the privilege of being part of the working group that developed the policy, along with CPSO Council, staff, and other external experts. For more than a year, the working group met regularly and took an in-depth review of the state of telemedicine around the world, including the positions and policies of other Colleges, provinces, territories, as well as international positions in other countries like the US, UK, and Australia. In addition to this, CPSO sought input from the public, physicians, and other organizations.
I think the revised policy is very enlightened and future-oriented, and encourages and enables the use of virtual tools in healthcare and medicine. It clearly outlines principles that the College expects physicians to follow when using virtual tools, and also looks at the use of telemedicine between providers and patients in a broad way, from using the telephone to real-time video conferencing.
The policy states that when using virtual tools in healthcare, the health care provider must maintain the same standard of care as for in-person care. Telemedicine events require an appropriate physical examination, history taking, full documentation, diagnosis recommendations, treatment thoughts, and follow-up accountability. The policy, however, does not put clinical or geographical restrictions on when and where a provider can use virtual tools. Instead, clinicians need to make a judgment call based on the reasons for seeing the patient, the circumstances of the patient, and if they believe that an appropriate assessment and treatment plan can be done virtually. If corollary would be missed, then an in-person appointment should be considered.
Last, there’s a very interesting and significant section around practicing across provincial and international borders. Colleges in North America license providers to work within their province, territory, or state, and virtual care allows providers to easily go from one jurisdiction to another, if necessary. CPSO looked at how to regulate those sorts of activities and arrived at the following position: if a CPSO member is providing care, whether it’s within Ontario or outside via telemedicine, CPSO will maintain jurisdiction with the member and investigate any concerns that might arise. Providers licensed outside of Ontario may come into our province virtually and see a patient under the license from the provider’s jurisdiction, without having to obtain a license in Ontario. Therefore the onus is on the referring physician, who’s referring their patient to an out-of-province consultant, to ensure that the referral is appropriate, just as they would if they were referring to a physician or consultant within Ontario. The referring physician must have reasonable grounds to believe that the out-of-province consultant is appropriately licensed and qualified to do the work that they’re referring their patient for.
Of all the different telemedicine polices I’ve read, this policy is amongst the most liberal and enabling anywhere in the world for encouraging physicians to engage in virtual care with their patients.
Check out the CPSO Telemedicine Policy and Patient Information Sheet and FAQs, and share your thoughts below.
