Approved by Council: April 2007
Reviewed and Updated: December 2014
Other References: Results from the most recent consultation
Policies of the College of Physicians and Surgeons of Ontario (the “College”) set out expectations for the professional conduct of physicians practising in Ontario. Together with the Practice Guide and relevant legislation and case law, they will be used by the College and its Committees when considering physician practice or conduct.
Within policies, the terms ‘must’ and ‘advised’ are used to articulate the College’s expectations. When ‘advised’ is used, it indicates that physicians can use reasonable discretion when applying this expectation to practice.
Telemedicine: Both the practice of medicine and a way to provide or assist in the provision of patient care (which includes consulting with and referring patients to other health-care providers, and practising telemedicine across borders) at a distance1 using information and communication technologies such as telephone, email, audio and video conferencing, remote monitoring, and telerobotics.
- Physicians who practise telemedicine must continue to meet the existing legal and professional obligations that apply to care that is provided in person.2 The practice of telemedicine is the practice of medicine, and a physician-patient relationship is established via telemedicine in the same circumstances as when a relationship is established in person.3
- For every patient and in each instance its use is contemplated for patient care, physicians must use their professional judgment to determine whether telemedicine is appropriate and will enable them to meet all relevant and applicable legal obligations, professional obligations, and the standard of care.
- When practising via telemedicine, physicians must:
- consider the patient’s existing health status, specific health-care needs and specific circumstances, and only use telemedicine if the risks do not outweigh the potential benefits and it is in the patient’s best interest;
- identify what resources (e.g. information and communication technology, equipment, support staff, etc.) are required, and only proceed if those resources are available and can be used effectively;
- ensure that the reliability, quality,4 and timeliness of the patient information obtained via telemedicine is sufficient, and that the patient is accurately identified;
- protect the privacy and confidentiality of the patient’s personal health information, specifically by:
- evaluating whether the information and communication technology and physical setting being used by the physician has reasonable security protocols in place to ensure compliance with physicians’ legal and professional obligations to protect the privacy and confidentiality of the patient’s personal health information;5 and
- taking reasonable steps to confirm the information and communication technology and physical setting being used by the patient permits the sharing of the patient’s personal health information in a private and secure manner; and
- ensure the physical setting in which the care is being delivered is appropriate and safe, including having a plan in place to manage adverse events and/or emergencies.
Expectations for CPSO Members when Practising Across Borders
The following expectations apply to all physicians who are members of the CPSO, regardless of where the physician or patient is physically located when telemedicine is practised.6
- When providing or assisting in the provision of patient care in another province, territory, or country via telemedicine, physicians must comply with the licensing requirements of that jurisdiction.7
- Before consulting with or referring patients to out-of-province physicians for care via telemedicine, physicians must:
- take reasonable steps to assure themselves that the consultation or referral is appropriate, just as they would when consulting with or referring patients to physicians who are physically located in Ontario;
- have reasonable grounds to believe that the out-of-province physician with whom they are consulting or to whom they are referring patients for care via telemedicine is appropriately licensed; and
- inform their patients that the out-of-province physician is not physically located in Ontario, and may or may not be licensed in Ontario.
- Physicians are advised to alert patients to the ‘patient information sheet’ appended to this policy, and communicate the relevant content contained in that document, as appropriate.
Expectations for Non-CPSO Members when Providing Telemedicine in Ontario
The following expectation applies to physicians who are not CPSO members, but who are licensed to practice medicine in another jurisdiction and who provide care via telemedicine to patients located in Ontario.
- Physicians who are not CPSO members must comply with licensing requirements in the jurisdiction in which they hold licensure and provide care in accordance with the standard of care.8
2. Relevant legal obligations include privacy and confidentiality requirements as set out in the Personal Health Information Protection Act, 2004, S.O. 2004, c. 3, Sched. A, consent requirements in the Health Care Consent Act, 1996, S.O. 1996, c. 2, Sched. A, and mandatory liability coverage in s. 50.2 of the General By-Law. Professional obligations are set out in the CPSO’s Practice Guide and policies (e.g., consent to treatment, confidentiality of personal health information, prescribing drugs, medical records, etc.).
3. The existence of a physician-patient relationship will be established having regard to the nature and frequency of the treatment provided, whether there is a medical record, whether the physician bills for the services provided, and any other relevant factors.
5. Physicians may want to consult the Office of the Information and Privacy Commissioner of Ontario, the Canadian Medical Protective Association, or an information and communication technology and/or privacy expert for up-to-date advice and questions about whether the technology and/or physical setting is secure. Physicians can also ensure their technology has reasonable security protocols by using a facility accredited by the Ontario Telemedicine Network for telemedicine.
6. The CPSO maintains jurisdiction over its members regardless of where (i.e. physical location) or how (i.e. in-person or via telemedicine) they practise medicine, and will investigate any complaints made about a member, regardless of whether the member or patient is physically located in Ontario.
7. The medical regulatory authority of the jurisdiction where the physician and/or patient are physically located may also require that physicians hold an appropriate medical licence in that jurisdiction.
8. If the CPSO becomes aware of concerns about care provided to an Ontario patient via telemedicine by a non-CPSO member, it may share that information with the regulatory authority that has jurisdiction over the member, so that appropriate action can be taken by that regulatory authority.