'Virtual Care is a Big Part of the Future of Medicine'

Anna Marrison of Borden Ladner Gervais Health Law Group sees telemedicine and virtual care as the future of healthcare in Canada. 

During her presentation at the Grand Rounds held at Ontario Shores Centre for Mental Health Sciences on June 18, she said it’s important to define a legal and medical framework for delivering virtual care as it becomes more popular.

“I see (virtual care) as a big part of the future of the practice of medicine in our province and our country,” she said.

Marrison cited the main concerns that arise from delivering virtual care as privacy concerns and documentation issues. It is important to mitigate the risks that could present themselves to physicians who decide to deliver this type of care, which can include anything from telephone calls, to e-mail and video conferencing.

The College of Physicians and Surgeons of Ontario has a policy as of December 2014 that says: “A doctor’s legal and professional responsibilities do not change simply because care is being provided via technology.” This is important to note because physicians delivering virtual care need to ensure the care they are providing is fully documented, private, and demonstrating the same quality of care that patients seen in-person would be subjected to.

“The documentation of information is extremely important,” Marrison said. “I want to stress that one.”

While telemedicine can be beneficial in many ways, there are limitations that must be accepted and addressed wherever possible. These include technology limitations (physicians may only have a partial view of their patients, and the quality of photos/video might not be clear,) language barriers, and the need to rely on other physicians or nurses for physical examinations and information. Challenges in the mental health context include a limited ability to evaluate and intervene if a patient is in crisis, difficulty detecting intoxication and an inability to assess hygiene concerns.

“It’s important to identify what the limits are, and address those,” Marrison said.

Marrison noted that informed consent and privacy are also important factors to consider when delivering virtual care. Patients need to receive adequate information about the risks and benefits of proposed treatment, and physicians need to be aware that the same requirements to meet privacy regulations under Personal Health Information Privacy and Access Act (PHIPAA) apply to telemedicine. It’s important to ensure that both patient and physician are in a setting appropriate for the exchange of personal health information.

There are a few things physicians and nurses can do to mitigate the possible risk factors associated with delivering virtual care. Developing and regularly testing evidence-based protocols, guidelines and documentation tools for delivering telephone triage, speaking directly with the patient whenever possible, verifying the patients location, collecting adequate information before forming a diagnosis or giving advice, thoroughly documenting telemedicine interactions, staying familiar with emergency resources and ensuring that health care organizations, nurses and other health care providers are screened to ensure they have the expertise to engage in telephone advice can all contribute to ensuring the future of virtual care reaches its full potential in the best way possible for physicians, nurses and patients.