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Regarding this part:
When providing or assisting in the provision of patient care in another
or country via telemedicine, physicians must comply with the licensing
This may require that physicians hold an appropriate medical licence
medical regulatory authority of the jurisdiction in which they are
This might need to be clarified. Does this mean the physician
practising telemedicine needs to be licensed in the territory he or she
is in when doing the consultation or that the patient needs to be in
the same territory in which the physician is already licensed? For
example, a physician licensed in Ontario is in Florida (where the
physician does not hold a licence) and does a telemedicine consultation
on an Ontario patient who is in Ontario. Would this be appropriate?
How about a physician in Ontario providing a telemedicine consultation
on an Ontario patient in Florida (Doctor not licensed in Florida,
Patient has a valid OHIP nnumber)?
What about an Ontario physician providing such services to non-Ontario
residents who are in Ontario?
What about an Ontario physician providing such services to non-Ontario
residents who are not in Ontario?
Yes it does mean the physician practising telemedicine needs to be licensed in the territory he or she
is in when doing the consultation and that the patient needs to be in the same territory in which the physician is already licensed.
If a physician licensed in Ontario is in Florida (where the
physician does not hold a licence) and does a telemedicine consultation on an Ontario patient who is in Ontario, this would be appropriate.
Similarly a physician in Ontario providing a telemedicine consultation on an Ontario patient in Florida (Doctor not licensed in Florida, but patient has a valid OHIP nnumber)
would also be appropriate.
The same is true for ontario physician providing such services to non-Ontario residents who are in ontario
but not true for an Ontario physician providing such services to non-Ontario residents who are not in Ontario.
As in these scenario the Liscence will probably have to be from a body like WHO and insurance will have to be from a similar body providing coverage by any physician /Pt encounter for anywhere in the world.
My TM consultations generally relate to chronic wound care on LTC settings.
They include history taking + inspection only.
(History provided by patient, caregiver, healthcare attendant of variable accuracy)
No palpation, percussion, auscultation;
No Doppler pulses,probing, debridement;
These consultations are hugely beneficial to remote immobile patients, BUT
require qualifiers pertaining to these constraints/limitations
The draft policy does mention the provision of medical services by physicians (both CPSO and non-CPSO licensed) to patients in Ontario while not being physically present in Ontario. I do worry that this will lead to patients being charged by outside/out of province physicians for medical services. These physicians who reside outside of the province, especially those who are not licensed in Ontario, are not going to be billing OHIP but rather patients for the provision of medical services. Patients who are faced with long wait times may be willing to pay to see a telemedicine specialist from abroad.
section of rural practice OMAappropriateness of referal should have geographical gradient. many specialists feel that in person consultation is medically appropriate – subjecting the patient to significant travel which has cost, including the risk injury during the journey.
Rural section would like the consideration of travel to be considered when considering the whether an in person consultation is required.
I have had mostly NEGATIVE experiences with Telemedicine. Specifically, as you see from the comments – it is TELE-health care – not HEALTH care. This is a FUNDAMENTAL difference – just like virtual reality is NOT reality. It is inappropriate for the CPSO to be licensing “Physicians to practice telehealth” without the Public fully appreciating the LIMITATIONS on tele-health services. I feel it is only a matter of time before a physician has to use the excuse – “well, I never actually SAW the patient” and that’s why I missed the rash/fever/leg movements/ signs or symptoms that are not readily accessable over telehealth connections. . .At present patients and physicians are totally self selected for these services which has also biased research findings – not only by conflict of interests, but by confusing relief with not having to travel 12 hours with efficacy and quality of medical services. I do not believe that specific licensing of “Teleheath practitioners” or assuming it is part of a General License will relieve these risks to both the public and the public. Although SPECIFIC uses and TRAINING may reduce risk, it will never be reduced to the rate of that of in person consultations.
Apart from this impossible to reduce risk there are a concerning number of other risks including privacy (encryption slows transmission a lot), expense (for dedicated lines and rapid encryption – $10,000 per site), the fact that the entire interaction is recorded and it’s effect on litigation, medical records preservation, identity proof (related to prescribing narcotics – if one would ever do that based on a telehealth consultation!!!) and of course follow up. Jurisdiction is probably solvable by simple policy (i.e. pick and answer and stick with it)- but my concerns are not resolvable by policy. I look forward to the Committee’s wisdom on this matter – especially in terms of the various conflicts of interests involved.
you make some comments that are not grounded in facts. For example, saying that thes interactions are recorded. This is not true. Telemdicine has brought care to many Ontario residents where provision of such care was previously impossible or not done.
In my opinion, the draft policy as currently worded places an undo onus on doctors in terms of assessing the security of telemedicine technology. We are not IT experts and lack the skills to assess encryption protocols etc. Telemedicine security needs to be regulated and MDs should only use (and OHIP should only pay for) telemedicine encounters using technology that has been approved regulators.
I like the fact that the CPSO draft policy addresses the need for this technology to be used outside Ontario (as I understand it, the policy right now is that both the doc and the patient must be within Ontario at the time of the telemedicine encounter). However, the focus of the policy seems to be on referring Ontario patients to non-Ontario MDs.
I don’t see this as being a big need. In terms of using Telemedicine outside Ontario borders- I see the 2 big issues being that we should figure out:
1. How can we ensure that an Ontario patient continues to have safe and secure access to their existing Ontario doctor via telemedicine when the patient is out of the province.
2. How can we ensure that Ontario docs can see their existing Ontario patients when the doc is out of the province?
Addressing these 2 issues would really help improve continuity of care, clinical outcomes and likely reduce costs (timely access to care, fewer repeat visits to the doc etc.). Referring patients to non-Ontario docs (which the policy addresses) is not as big need in comparison to the need to for Ontario patients to see Ontario docs with whom they already have an existing relationship REGARDLESS of whether or not the patient and the docs are in Ontario at the time of the telemedicine encounter.
1) What is to prevent physicians who do not have a licence anywhere in Canada from practicing telehealth?
2) More importantly, what is to prevent physicians who have had their licence revoked or suspended from practicing telehealth?
3) I work in an Emergency Department in a large urban area in Ontario. There is a nearby walkin clinic that has telehealth physicians. We have had patients directed to our ED after having waited many hours at the walkin clinic to see a telehealth physician only to be told by the telehealth physician to now go to the ED as he/she needs a prescription (not a controlled prescription) and the telehealth MD is not allowed to prescribe in Ontario. How is this providing a service to these patients?
As a patient I agree with your concerns. It is not useful to a patient to obtain diagnosis that requires medication if this cannot be provided by the telehealth practitioner. I would assume that in addition to providing care there is an element of concern for cost of treatment. Forcing the patient to be seen twice is not cost effective for the healthcare system and will leave patients dissatisfied with the care.
I too would prefer not to “see” a doctor with a revoked or suspended license, as well as generally having a disinclination to consult with doctors in other countries. For one thing medicines they might recommend may not be available here or may have different names and approved uses.
Telemedicine is an important technological breakthrough for medicine. It improves patient care especially in rural Canada. To stop this service would be a disservice to rural Canada. As to where the patient is located how does it matter. The patient is a tax paying health seeker and believes in continuity of care from his (For example ) Ontario doctor. If the doctor is away out of province or country the doctor’s dedication to provide the quality of care even while away should be applauded especially to some of the rural locations. There are patients who have difficulty in accessing their FP or GP and if their own doctor is willing to assist them when they need them why should it be prevented. This should be made possible only for a physician who
holds a qualified MD and FRCP license from Canada. And CPSO has given him or her license to practice in Ontario. Telemedicine has assisted so many patients with the telestroke program. It will be a shame to change it. Northern Ontario connected by a highway of information to assist patients with the best possible care will suffer if too many legal obstacles are placed. As long as the physician is licensed to practice medicine and is legally providing this patient care in a legal way and is a tax paying law abiding physician we should not make it difficult for telemedicine canadian physicians from providing patient care.
Current policy is reasonable BUT the increasing use of telemedicine need to be cautious with increasing use re
1.accuracy of information transferred from physician( or alternate-caution) to patient, and interpretation of transported information is accurate as per office exchange, or the telephone discussion.
2.? Role of Nurse or RPN representing the Physician- need definition, standard
3.Confidentiality is a major issue to be considered as telemedicine expands
Conclusion: A growing means of communication. The office visit exchange, or the telephone consultation will rapidly be replaced. Potentially useful but Need to ensure Patient safety & confidentiality.
Ontario Addiction Treatment CentresDear Telemedicine Committee Members:
Thank you very much for allowing me the opportunity to comment on the Draft policy regarding the use of Telemedicine. Let me also commend you all for the work done up to this point.
One area of concern that remains outstanding involves the use of telemedicine (OTN) within the context of a Methadone Maintenance Treatment Program (MMTP). Specifically, the current MMTP Guidelines published by the CPSO include a section on Telemedicine (see S.16, Telemedicine in the Delivery of MMT, page 88). I have attached it here for your quick reference.
While not included in the MMTP Guidelines, the Methadone Committee maintains a position that any prescriber wishing to use telemedicine to treat patients remotely must have undergone a successful one year assessment.
The Committee maintains this position for reason of patient and public safety. However, I can find no researched based evidence that supports the a new prescriber practicing by telemedicine represents any increased threat to patient or public safety. In fact, I believe the this position restricts access to remote communities and thereby introduces a measure of harm to both patients and the public living there.
Many physicians engaged in MMTP live in urban settings such as Toronto whereby there are no significant wait lists for care. This deters physicians from entering into the actual practice of MMTP, once licensed, as they can’t secure a viable practice. However, given the need to service many patients needing care in remote northern communities, I believe the position of the Methadone Committee is short sighted and in need of your committee’s attention. No other medical specialty is required to wait a full year. Psychiatrists can practice telemedicine within their first year of practice. For example, I routinely care for patients incarcerated in our Provincial Correctional facilities. Many of these inmates are on methadone. When I introduce a new physicians, such as Psychiatrists or Emergency Medicine doctors, who also hold a newly acquired methadone license, they are not able to see inmates by OTN who are on methadone but are for any other issue (suicidality, overdose, general care). It is therefore very limiting and I am unable to find the scientific, evidence based rational for it.
Once again, I thank you for allowing me to offer my comments and I welcome any feedback you may have to offer.
Fully agreed, also:
The methadone committee policy for telemedicine is also discriminatory for the following reasons:
It expects the prescribing physician to do a physical exam by the prescriber within 6 weeks. It is not clear in the policy if this physical can be provided by a local physician, and if not why not?
The prescription of no other medication has this requirement. Is the prescription of b-blockers, powerful diuretics, chemo less risky than methadone?
The policy also requires the availability of onsite counseling services whereas this is not required for inperson methadone clinics.
There is no evidence or even anecdotal cases to validate any of these requirements.
I agree with the provisions of the draft policy here under review.
However, currently, addiction medicine is the only part of medicine that has its own CPSO rules on telemedicine in Ontario.
The current methadone committee policy for telemedicine is discriminatory against addiction physicians and hence their addiction patients for the following reasons:
1- It expects the prescribing physician to do a physical exam within 6 weeks. It is not clear in the policy if this physical can be provided by a local provider, and if not why not?
2- The prescription of no other medication has the requirement for a physical exam by the prescriber. Is the prescription of b-blockers, powerful diuretics, chemo less risky than methadone not to require a physical exam by the prescriber?
3- The policy also requires the availability of onsite counseling services whereas this is not required for inperson methadone clinics, and only suggested.
4- the methadone committee does not approve that a methadone prescriber treat patients via telemedicine for the 1st year of their practice. Does the CPSO also prevent oncologists, psychiatrists, and family physicians from treating patients for the first year into practice on telemedicine?
There is no research or even anecdotal evidence to validate any of these requirements specific to prescribing methadone on telemedicine. The specific policy of the methadone committee should be removed and put in line with other areas of medicine that will be covered by the new draft policy.
I want to say that ‘telemedicine’ may still be limiting. I live in a remote area and I have to drive to the nearest telemedicine site which is 45 minutes away on a good day, in the snowbelt region. I would have gone broke this winter if that had been my only source of income at this point in my career. The white out days were numerous.
I would prefer to be able to Skype with a client/psychotherapy patient, who has to cancel because of a sowstorm and I would like somehow for that to be built into the guidelines as acceptable. What is the differerence between Skype and telemedicine except for that some third party will be benefitting from the technology? There are breaches of privacy left right and centre with EMR which we have now been gently coerced into using (thank god my mom taught me to type when I was 8! But I digress…)
Perhaps it already is built into the new propsed guidelines, I have not read through thoroughly but I know Skype is not an option now.
There is my feedback! Thanks
have you talked to OTN about PCVC? if not, then you should, because it addresses what you just asked about.
I think we need to separate telemedicine policy and concerns into: OTN vs Other.
Many of the issues in question regarding licenses and security of data are taken out of the equation if the provider is registered with OTN and the patient is seen at an OTN accredited facility.
Telemedicine is medicine. The standard of care needs to remain the same. As an experienced OTN provider, I believe that this is definitely the case for my encounters. For certain visit types, a physical exam may be necessary and in that case, there are several ways that can be accomplished (use of telemedicine exam equipment, delegation to local healthcare practitioner, etc).
Regarding the comments raised by the addiction physicians, I agree that it is absurd to single out one area of medicine to play by different rules. As I said before, telemedicine is medicine. As long as the physician can ensure that the standard of care is met, there should be no difference from one area to the next.
Lastly, for those who do not know – physicians are not allowed to bill OHIP for seeing patients if the physician is physically located outside of Ontario at the time of the visit. This is true even if the patient is an Ontarian, being seen from a licensed OTN facility while their physician is at a conference in Montreal. This is a laughable policy which demonstrates that many people still do not understand technology. Perhaps we can lobby OHIP to change this rule and get us closer to the 21st century?
If my regular family doctor were willing and able to consult with me via telemedicine when she was not in Ontario I think she should be able to bill for the consultation.
I live in an urban area and am not familiar with OTN. I was assuming that patients could access telemedicine from their home computers. I hope that is correct
Telehealth has limitations and the potential for billing poor quality care for a very high price is ever-present.
That said, teleheatlh has the potential to significantly improve psychiatric care for people in Northern, Rural and Remote areas. Northern communities in particular have embarrassingly poor access to psychiatric and mental health services with the resultant epidemics of psychiatric disorders.
Telehealth is not the only answer – but well thought out and well organized tele health services could be a start for providing a basic level of care for people, who in this well-resourced country, have none and are experiencing unnecessary morbidity, mortality and violence as a result.
I think the proposed policy is well thought out and is a very useful document.
It raises the issue that the technology evolves continually and that the changes may bear on the ability to assess patients. I think it warrants more detail or an accompanying document in terms of limitations and management. I see patients with chronic wounds by telemedicine. I attempt to address my inability to assess depth of wounds or palpatory findings by seeking the assistance of a doctor and/or nurse who is with the patient.
There may or may not be the opportunity to auscultate.
There are implications in terms of liability and documentation which may be pertinent. There may usefully be guidance about situations which lend themselves to telemedicine (e.g., titrating treatments from laboratory results in follow ups of patients) and ones which do not (requirement to palpate, such as assessing abdominal pain).
As well, the document addresses jurisdiction in regard to borders. There is no discussion of hospital jurisdictions. What is the relationship of patients with the venues where they are seen for the telemedicine encounter? Surely, it depends on why they are using that place, if it is a venue of convenience or if they have a pre-existent relationship, for example, as an in-patient of a hospital. It requires clarification in the document, to delineate liabilities and jurisdiction. Clinical research may also be done via telemedicine and the question of jurisdiction is important and unanswered.
133 – How is a physician supposed to know the licensing requirement of each jurisdiction in which the telemedicine patient is located? (For those patients outside Ontario.) This would be very time-consuming to determine and makes the whole telemedicine process impractical, when it is supposed to be improving accessibility of remote patients to MD care. Please remove this requirement.
89 – Doesn’t telemedicine ALWAYS have an inherently higher risk than in-person care?
Even something as benign as a resident giving a Ativan order to a nurse over the phone for a hospital patient is telemedicine, and has a higher risk then seeing the patient in person, looking at the chart etc. If the policy is left as-is, this would not be allowed! Please remove this line.
96 – Emphasis on security protocols is not needed, since we are already bound by privacy legislation. “Reasonable security protocols” is also vague and difficult to interpret.
I work in LTC in an urban setting, but my aged patients who have chronic illness might as well be living in the extreme North for all the access they have to specialist care. Visits outside the Nursing home are often limited to crisis care in the ER. We have tried telemedicine but it is limited by the availability of the equipment and the number of specialists who are willing to sign up for a session that may, but usually doesn’t, fit in with their already busy day. I think the security concerns with programs like Skype are a little overdone. Sure, the conversation is not encrypted, but anyone who is determined to overhear can simply listen at the doctor’s door or place a listening device in his consulting room or the patients bedroom. I’m glad that the policy leaves reasonable decisions for security and privacy up to us. Laptops and ipads are commonly available whereas bulky telemedicine machines are not.
Videoconsults would be great for dermatology, wound care (see below), follow-up specialist visits, diabetic care, in fact all visits that do not require high-tech intervention or investigation.
Ontario Medical AssociationResponse in PDF format.
I think this looks very reasonable. Do you have the ‘patient information sheet’ prepared yet? I would be very interested in its contents. Thank you for your proactive work on this.
Thanks for the opportunity to provide feedback on the telemedicine policy paper. I have been the specialist co-lead of the [identifying information removed]. This is an eConsultation service (physician to physician) with over 48 speciality services involved and to date over 3000 eConsults processed.
My main concern is with the definition of telemedicine. I think we need to differentiate physician to patient virtual consults from physician to physician. When giving another opinion to another physician, without seeing the patient whether face to face or by video, it is my understanding that the expectations are slightly different. It is the responsibility of the consultant physician to give reasonable advice with the information provided (this may include being unable to give advice without seeing the patient) It is the responsibility of the requesting physician to interpret/apply advice received.This is the same for “hallway”, telephone and other “informal” consults.
With the expansions of physician to physician “virtual” consults there is a need for a policy on them, but I don’t think this policy addresses them and should explicitly state that.
Given our experience in physician to physician eConsultations , we would be happy to act as a resource if you are developing a policy to address this group of consults.
Hello… i have provided feedback in the survey online however wanted to provide you with the WONCA policy on telemedicine to help inform your guidelines as they pertain to small communities. There is a risk to small communities that telemedicine be used for remote primary care (see attached ad from CFP). This risks disrupting the kind of service that we need rural physicians to be providing – generalist full scope practice in clinic, hospital and home in small communities. There has been evolving conversation on the rural med listserv (National) about physicians in urban settings offering to enroll rural patients with the goal of providing them with primary care via telemedicine. While providing some measure of access to people who otherwise struggle with access in underserved communities, the risk to this model is the destabilization of existing groups and loss of generalist skills in service to rural communities.
A statement in the CPSO draft document regarding the goals of improving access for the WHOLE community, and supporting local physicians to provide better more comprehensive local care is important.
Attached please find the WONCA document that references this in Recommendation 8.
Attached also is the ad which I mentioned that discussed “practicing rural medicine” as opposed to “practicing telemedicine” and I think that this kind of semantic challenge poses risk to our notion of rural medicine and what it is that we need current learners to embrace and understand.
Thank you for considering this feedback. I would be happy to discuss this further should you feel this would be of value.
My only concern is that the technical standards of the equipment used should meet the Ontario requirements.
I have used telemdicine a lot and have the following to share. The policy should be clear on that:
1) It would be important to have a medical setting situation at the point where the patient is receiving service via telemedicine. This could be a hospital, clinic, infirmary, etc. One should have reservations about connecting via telemedicine to a patient is not situated in such a setting. There should be ancillary staff present at the patient point to assist the physician in taking orders, prescriptions, etc. The patient should not be forced to be in the same room as the ancillary staff due to privacy concerns. The patient should be allowed to speak to the physician one on one, if the patient requests. The ancillary staff can be present in the next room perhaps connected in real-time electronic communication with the physician on an instant messenger type of system that meets privacy requirements.
2) The physician providing telemedicine should be situated in a private setting where patient privacy on screen and sound can be assured. For example the physician must not be sitting in a public area like restaurant, coffee shop, outdoors, or airport. The physician must connect only from a place where privacy of the video call is assured such as a private office/room at hospital, clinic, or home.
3)The physician should have access to real time electronic services such as scanner, fax, email , etc. while in the call, in case he or she has to make orders in writing and/or sign forms/documents.
4) a system approved for privacy and security with real-time live technical support such as OTN (Ontario Telemedicine Network) should be used. Use of consumer systems without meeting requirements such as Skype, video call, cell phones etc should not be approved.
Specifying specific technologies would seem outside the realm of the CPSO – would it not be sufficient for patient and provider to agree on the technology they wish to use in the form of acknowledging its privacy and security limitations?
Read with intrest.As a physician I do telemedicine with my patient to discuss there care re drug use control of blood glucose anticoagulants. Often discuss with dentists re the medications patients using how to manage dental care while taking certain medications .Often discuss with patients or family in the absence of their physicians who I agree to cover. Often my patients inform me the talk via telephone and got advice often with physicians but others inform me they are not clear whether talking to nurses physicians or someone else. It is suggested it is better they should know whom they are talking to. Telemedicine I feel is serving public well provided the communication is directed to particular need of the patient. I had discussion with public they are benefitted with managing infant care baby needs children health needs
Telemedicine is rapidly evolving – in some cases, telemedicine services have been treated as ‘uninsured’ due to the slower pace of evolution of physician payment for services provided other than ‘physically face-to-face’ which has created conditions where physicians charge patients directly. Has there been consideration of addressing payment for telemedicine services within this or other policies?
I have a few comments to add to this discussion:
Having practised GP Psychotherapy for many years in Ontario, I have now had the experience of a few years of providing the same service to Ontario patients from outside the country via telemedicine. This has given me the opportunity to compare experiences and outcomes.
GP Psychotherapy via telemedicine would seem to be every bit as effective as in person; I’d venture to say even more so. People seem to relax much more readily into a situation where distracting physician cues are minimized in this way. I’ve had excellent outcomes in relatively short time frames.
Regarding equipment – my experience has been with OTN equipment sent out to me at my cost of $10,000. I worked with OTN as an international link and benefited from their excellent help desk on occasion. The quality of the interaction, despite being from the other end of the world, was excellent. Within minutes one forgot that the patient wasn’t in the same room. Technology is now evolving to allow for direct access to patients’ devices in their homes, with encryption for security, at a far lower cost.
Patient safety has always been a top priority. I have always required the following:
– A local GP or NP who prescribes and monitors all medications with input from me – via the patient themselves – if a change is required. This gives local hands on care which is very helpful. I have chosen not to prescribe long distance at all.
– A phone at the site for immediate verbal reconnection in the unusual event of technology failure, so that the appointment can be wound up in a controlled manner.
– A medical or other responsible resource in the immediate vicinity eg. clinic in action at the time, or hospital emergency room on site or nearby that the patient and I can together call on for immediate help if needed.
– Careful selection of patients – working at a community care center I insisted on the patient’s customary helper being present throughout the appointment when presented with unknown or emotionally brittle cases. (The vast majority of patients did not need this extra level of care).
– All patients being called upon to understand and sign a form accepting their own responsibility to some extent as well where possible, and to undertake to notify me and/or local medical services immediately in the event of mood changes etc. I also outline the newness of this technology, pros and cons etc.
– Patient knowledge of all local medical resources and phone help lines etc.
– Family contact as a last resort, although I have never actually used this to date.
This supportive network has worked very well indeed and minimizes the sense of distance.
The ability to talk to a physician from outside one’s community has been invaluable, particularly in small communities where confidentiality is almost impossible to attain. In general it has been sobering to discover how critical the shortage of mental health care has become in many parts of Ontario. Telemedicine has been outstanding as a means of contact in these situations.
Regarding required qualifications for physicians offering medical care to Ontario patients: I would suggest that Ontario-licensed physicians providing care to Ontario patients should be facilitated under all circumstances, wherever they may be. People move around in life, and the security of an established therapeutic relationship governed by CPSO rules and guidance of known quality should ensure the level of care. In the psychotherapeutic sphere, cultural factors can be very important and telemedicine provides a way of of retaining these valuable Ontario resources over time.
OHIP remuneration for such critically needed services by an Ontario licensed physician should, in my opinion, be provided at the soonest opportunity regardless of location; there is a really desperate need.
Other factors may affect other branches of medical work and non- Ontario physicians, and of course medico-legal issues factor in too.
I would like to comment on the matter of requiring that a physician licensed in Ontario also be licensed in their alternate location as well – this is likely to prove a fairly onerous burden to many, keeping up with all the requirements of two Colleges, particularly if they are only in their alternate location for short periods of time.
I would suggest that CPSO licensing would be enough.
My experiences of practising via telemedicine over many years now, have been very good indeed. Therapeutic alliances establish quickly and I have never to date felt out of control or had a negative outcome. With safeguards in place and technology more than adequate already and improving rapidly, this is the way of the future. In my opinion the College should facilitate it as much as possible. Please let me know any way in which I can help.
I practice psychiatry. I did telepsychiatry durind a sabbatical while I was in [identifying information removed]. I continued to follow my clientele for few months. It worked well. At that time OHIP was covering these visits.
One problem happened is the application of Mental Health Act. After an assessment, a physician may fill a form to force a patient to go to emergency for his safety or safety of others. The setting where the patient is should be ready to help this process safely.
There is no specific mention of that in the Policy. Only in # 1 General expectations «physicians’existing legal obligations»
Does it refer to the Mental Health Act as well? Would it be better to mention it scecificaly. I think to the Substitute Decision Act as well.
I would like to see the policy include the expectation that physicians are required to use telemedicine when it’s in the patient’s best interest.
We know that: 1) the CPSO’s mandate is to act on behalf of patients; 2) that telemedicine is being shown to be better than in-person care in more and more circumstances – arguably it’s best practice in a number of situations; 3) that in-person care can cause unnecessary risk to the patient and create unnecessary travel costs to the patient and the system; and 4) that telemedicine technologies are readily available to physicians across the entire province.
However, there is nothing to hold physicians accountable for opting out of using telemedicine. In the current environment, a physician can choose not to use telemedicine for any reason, such as they don’t feel like it, they aren’t well enough informed to know the value of it, it would disrupt their current routine, etc.
This is exactly the type of situation where the CPSO should step in. If a physician was negatively impacting patient care by practicing with clinical knowledge that was out of date, a patient could make a complaint based on existing CPSO policy. But if the physician is negatively impacting care by practising with technical knowledge that is out of date, the patient would have no grounds.
From my perspective, the Telemedicine policy doesn’t go far enough to truly enable quality patient care. Please build a policy on the expectation that physicians must use telemedicine when it’s in the patient’s best interest, and then the rest of the policy should be a “how to” guide that makes it easy for physicians to do just that.
forcing a physician to use telemedicine would be like forcing a physician to set up office in a location he/she doesn’t want to. All telemedicine does is allowing someone to be somewhere, so I don’t think the CPSO should force physicians to use it, just as it does not force physicians to be somewhere they don’t want to be.
Ontario Association of OptometristsResponse in PDF format.
Ontario Telemedicine NetworkResponse in PDF format.
Ontario Addiction Treatment CentresResponse in PDF format.
Professional Association of Residents of OntarioResponse in PDF format.
College of Physicians and Surgeons of AlbertaResponse in PDF format.
Canada Health InfowayResponse in PDF format.
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