Telemedicine services and regulatory compliance: Important points and questions to ask

Beginning in October 2018, physician regulators in three of Canada’s four largest provinces - Alberta, Quebec and British Columbia - have released legal, regulatory and ethical guidance for physicians providing telemedicine services.

The rules are very consistent, and they affect both the Canadian telemedicine industry and the businesses who offer telemedicine access as part of their employee benefits. Several telemedicine providers will have to make operational changes, and some are impacted more than others.

We are proud to announce that Dialogue’s operations are unaffected as we are compliant with all three regulatory colleges' published requirements:

1. College of Physicians and Surgeons of Alberta - October 2018
   

2. Collège des Médecins du Québec - April 2019
   

3. College of Physicians and Surgeons of British Columbia - May 2019

The principal physician obligations in these three documents are:

1. Respect the same standards of best medical practice for performing patient assessments. If the standard requires a physical examination that can only be properly performed in-person, the assessment must not be performed via telemedicine.

2. Protect patient privacy and confidentiality. This includes protection during the encounter and safeguarding all information that the physician collects.

3. Obtain informed consent from the patient for an assessment via telemedicine and document the consent in the patient record.

4. Disclose the physician’s identity, location and licenses/permits, and validate the patient’s identity.

5. Maintain proper medical records for each patient and encounter. The records must be properly secured, retained for at least five years and be accessible to the patient. Records cannot be shared with any third party without patient consent.

6. Ensure all appropriate follow-up for patients assessed via telemedicine. In the case of abnormal test results, the physician must notify the patient and send the results to any physician who manages the patient follow-up.

7. When writing a prescription, the physician must adhere to all standards for the required elements to include in the prescription and sign appropriately. Physicians are prohibited from prescribing opioids and controlled substances.

8. Physicians must safeguard their professional autonomy and not allow any provider of telemedicine services to influence their choices of tests, referrals or treatment, or direct patients to specific facilities.

As a result of these recommendations, we suggest that any organization that is using or considering a telemedicine consider the list of questions below and ask them to their current or potential providers.

1. Does your services limit its scope of practice to assure healthcare professionals provide only the safest possible care via telemedicine? How is the quality of the services, and the adherence to the scope of practice, tracked?

2. Within the safe scope of telemedicine, do the service’s doctors accept all patient requests for assistance and avoid giving preference to easier, less complex cases, or can doctors choose to ignore more complex cases? In particular, does it respond to all requests for mental health issues or problems that will require referrals for tests or to specialists?

3. If the standard of care for a patient's problem requires a physical examination, do you always refer the patient to see a provider in-person? And do you help the person to find a professional or facility that can perform the needed assessment?

4. Does the service clearly inform the patient of the benefits and risks of telemedicine and obtain explicit patient consent by video at the start of every encounter?

5. For prescriptions, does the format and means of sending meet guidelines for authenticity and privacy? And are the prescribers vigilant about avoiding medications that are not allowed to be prescribed by telemedicine? How is the quality of the prescriptions, and the adherence to the prescription guidelines, tracked?

6. In cases where the patient requires follow-up, is the service able to manage incoming reports and arrange repeat appointments with the same doctor?

7. Does the service maintain patient encounter records that meet all requirements, including retaining them for the prescribed time and sharing them with other doctors at the patient's request?

8. Is patient access to the service's doctors prioritized only by patient need rather than by other considerations?

9. Does the service allow its physicians to make referrals for tests and treatments at the facility of their choice rather than the preferences of the service?

10. Does the company have a medical leadership team that monitors quality of care and sets standards for all providers to use when caring for patients?

11. Is the telemedicine provider SOC2 compliant with respect to handling your business’ and employees’ confidential information? And does it have privacy and compliance professionals that assure continuous oversight and adaptation of processes and standards?

It is important that your telemedicine provider adheres to all regulatory recommendations to assure that patients receive the best quality care.