The College recognizes the role virtual care plays and will continue to play in the provision of medical care to Nova Scotians.
The medical profession is still learning about the strengths and limitations of virtual care. The decision by a physician to provide virtual care requires an exercise of professional judgement considering the circumstances and condition of the patient.
The regulation and provision of virtual care is quickly evolving. The College will be revisiting this standard on a regular basis to keep pace with this evolution.
Physicians licensed in Nova Scotia who deliver virtual care to Nova Scotians are subject to the regulation of the College, irrespective of where the physician is located.
Physicians licensed in Nova Scotia who deliver care into other jurisdictions in Canada will be held to the standards of that jurisdiction, while subject to the regulation of this College.
Physicians licensed elsewhere in Canada who deliver virtual care into Nova Scotia will be held to Nova Scotia standards but subject to the regulation of their licensing authority.
1. offer virtual care to patients only in conjunction with in-person care, not as an absolute alternative to in-person care;
2. coordinate their clinical schedules so that patients have reasonable access to either in-person care or virtual care as required;
Physicians are encouraged to review the College’s Professional Standards and Guidelines Regarding Informed Patient Consent to Treatment. In addition to the requirements of this document, the patient-consent process for virtual care services must ensure the following information is reviewed by the patient:
In reference to the new Nova Scotia Department of Health and Wellness policy, “Provision of Publicly Funded Virtual Health Services”:
“Patients have the right to choose an in-person visit and/or refuse a virtual appointment. Health professionals will work with patients to determine the best modality for the patient encounter (in-person or virtual) while adhering to practice standards, protocols, and Public Health guidelines outlined by relevant health profession regulatory bodies/DHW/NSH/IWK and using professional judgement, while also prioritizing patients’ preferences and needs for virtual or in-person encounters. Offering virtual visits should not contribute to increased patient isolation.”
provide care consistent with accepted standards of practice. Virtual care must not compromise the standard of care;
not prescribe opioids or other controlled medications to patients whom they have not examined in person, or with whom they do not have a longitudinal treating relationship, unless they are in direct communication with another regulated health professional who has examined the patient;
inquire whether the physical setting in which the care is provided is safe, appropriate and provides for confidentiality;
use virtual care systems that ensure confidentiality. If not possible, inform the patient that the method of virtual care does not guarantee confidentiality. Disclose the risks of a virtual visit and obtain verbal consent and record in the chart;
Physicians must review the Nova Scotia Personal Health Information Act. Note that certain communication technologies may not adequately protect the security of personal-health information. Physicians may wish to consult with the Canadian Medical Protective Association.
if the physician determines that an in-person assessment is required, the physician must schedule an in-person assessment as soon as the patient’s presentation requires; and
if the physician determines that the patient needs to be seen in-person by another physician or discipline, the physician must advise the patient, direct the patient accordingly and document their reasoning.
Across the nation, hospitals and health systems are reshaping virtual care programs to be more accessible, affordable and responsive to patients, clinicians and care teams. The challenge is: How do you capture best practices of in-person visits and evidence-based medicine while adapting to the unique setting of virtual care?
Mental HealthFour leaders of clinical transformation, innovation and marketing from The University of Texas MD Anderson Cancer Center (MDACC) and Texas A&M University’s Mays Business School recently shared a blueprint in the Harvard Business Review.
The so-called “DIBS” framework — documentation, integration, best practices and support — offers benefits for all virtual care stakeholders. The report provides insights drawn from implementing a suite of virtual care services at MDACC and operating procedures and virtual care guidelines at other institutions, including the University of Pittsburgh Medical Center (UPMC) and Jefferson Health.
Include all unique activities of health care staff for a typical virtual care encounter. Compare and contrast in-person and virtual care contexts based on the patient’s reason for the visit. This comparison can help uncover process complexities that may arise unexpectedly when transitioning from in-person to virtual care. Categorize care-related activities before, during and after the visit and guide the technical assistance process for patients who have specific visual, auditory, language, technology literacy or technology infrastructure needs.
Educate them on how to look at the camera during conversations, and choose appropriate lighting and audio equipment.
Streamline all ancillary logistics that complement a virtual visit, including making future appointments, ordering prescription refills and incorporating personal health information captured on in-home devices.
To gain trust and buy-in, prepare patients and caregivers for self-monitoring and self-care with educational materials (e.g., tip sheets and links to training videos) and ensure that all communication is culturally and linguistically competent and clear.
Use evidence-based decision criteria to guide appropriate use of remote care (e.g., for lower-complexity and lower-emotion visits).
Use evidence-based decision criteria to guide appropriate use of remote care (e.g., for lower-complexity and lower-emotion visits).
Encourage clinicians to review patient information and records (including, when possible, notes from other treating physicians) before virtual encounters.
Involve the entire care team (e.g., nurses, medical assistants, etc.) in preparing for the virtual visit, gathering records and prepping the virtual room, connecting during the visit and scheduling appointments as the visit ends.
Prioritize best practices that enable clinicians to adopt and sustain virtual care. Clinician benefits include greater efficiency, improved outcomes and patient experience scores.
To preserve these benefits, codify virtual care workflows where feasible and refine them as new service line-specific needs arise.
Timely support for virtual visits and the surrounding infrastructure is essential. Invest in ready-to-serve tech assistance for patients, clinicians and clinical teams. Ensure adequate supply chain redundancy to solve potential device or connectivity issues.
Explore using artificial intelligence (chatbots, virtual nursing assistants, clinical support algorithms) to aid patients and clinicians as they seek evidence-based guidance. And minimize the digital divide and access to care disparities by possibly installing a telehealth center with private cubicles in low-income housing complexes, community centers or other locations.
In rural South Central Texas, consumers can use a telemedicine station at the Milam County Sheriff’s Office to get immediate help when clinics aren’t open, potentially saving them a 35-minute trip to the nearest hospital.
Once inside the booth, patients can check their vital signs, access a dispensary with common medications and have an on-demand video visit with a nurse practitioner. The station is a collaboration between Texas A&M Health Science Center and OnMed, which manufactures a self-contained virtual medical unit that connects patients with licensed clinicians and pharmacists.
MDACC, meanwhile, offers a remote-monitoring program for patients undergoing immunotherapy. This effort has significantly reduced emergency department visits and led to greater patient satisfaction.
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