CPSA Advice to the Profession: COVID-19 Virtual Care
This is applicable for the duration of the COVID-19 pandemic

  

CPSA Perspective
The COVID-19 pandemic is putting extraordinary pressure on the health care system. CPSA recognizes physicians may be put in a situation where compliance with some of our standards or practice may not be in the best interest of their patients and may not be possible.  We expect physicians will always practice within the scope of their training and expertise and act in the best interest of their patients. 
 
CPSA Advice
The College of Physicians and Surgeons of Alberta is committed to ensuring that physicians have the capacity to provide quality patient care in the face of the COVID-19 pandemic. Central to this effort is the importance of limiting viral spread by:

  • Reducing unnecessary patient and physician travel within Alberta, and between Alberta and other jurisdictions;
  • Reducing unnecessary patient presentations to health facilities, and;
  • Enabling physicians to provide remote patient service within Alberta or from other jurisdictions.

The adoption of virtual care practices can help achieve these goals by enabling the remote:

  • Screening of patients who are worried or ill;
  • Care of patients with suspected COVID-19;
  • Care for other patients in your practice with the intent of decreasing exposure to those who may be ill; and
  • Care of patients when the physician is self-isolated, but well enough to work.

What Can a Physician Do?
Screening:

  • Use the phone, EMR-enabled virtual tools and/or video conferencing, if available to:
    • Assess illness
    • Triage for care or screening
    • Record clinical notes from virtual visits in the EMR chart
    • Direct patients quickly:
    • for self-care;
    • for an in-person visit;
    • to screening/testing facilities; and
    • to an acute care facility (ER) when required.

Care for patients with suspected COVID-19:

  • Use virtual means to keep contact with patients who have symptoms and who you are monitoring.
  • Reassess patients virtually, and if worsening arrange appropriate follow up.

Care for regular patients by virtual means whenever possible for the following reasons:

  • To avoid unnecessary trips to the office.
  • To manage patients with chronic disease.
  • To manage other acute illness that may not require a physical exam.

Virtual Care Tools
Virtual care is enabled by digital technology that permits the communication of health information across locations. Although there are current efforts in Alberta to rapidly deploy an enterprise video-conferencing solution, as well as patient and provider portals, in the time-frame required for an appropriate response to the COVID-19 pandemic the Alberta eHealth environment lacks some important assets, notably:

  • Enterprise secure messaging between providers (physician-to-physician) and physician-to-patient;
  • Enterprise video-conferencing between providers (physician-to-physician) and physician-to-patient.

There are many virtual tools that can be used to help provide the best care in a rapidly changing outbreak environment. Health-specific platforms are usually regulated (privacy and security compliant) while more readily available consumer applications are unregulated and do not provide health system-level privacy and security compliance. If you have access to a regulated virtual care platform, CPSA recommends this be used for patient care. However, CPSA recognizes that in the extraordinary circumstances posed by the pandemic where patient safety may be compromised by a delay in deployment of virtual care technologies, that short-term use of unregulated virtual care technology can be justified. If an unregulated platform is to be used, encrypted applications are preferential to unencrypted applications.

A list of common unregulated virtual communication platforms includes:

  • Skype and Teams by Microsoft
  • Facetime by Apple
  • Zoom Basic (Zoom also has a regulated platform)
  • Google Hangouts
  • Whatsapp by Facebook
  • Doxy.me
  • Texting
  • Regular email
  • Many others

 
Consent
When using unregulated virtual platforms for health purposes, it is recommended that express patient consent is obtained. This is achieved by:

  • carefully establishing that the identity of the patient is correct;
  • explaining to the patient at the start of the virtual encounter that:

“Unregulated virtual care technologies increase the risk that your personal health information may be intercepted or disclosed to third parties. These tools are being used as an extraordinary measure during the COVID-19 pandemic when regulated technology is not readily available, and the necessity to keep people from congregating or attending health facilities where they may be exposed to the COVID-19 virus is thought to outweigh the risk of personal privacy breaches on both a personal and population health basis.”  

To support this consent process, we suggest that the following information be added to your service website, posted in your office, forwarded to your patient panel, or made available to patients as a reference when you obtain verbal consent:

 “COVID-19 is placing stress on Canada's public health system. Our health service is starting to offer virtual care to make sure that we can continue to care for our patients safely and effectively. This means that we will be using video and audio technologies for some patient visits rather than asking all patients to come into our office. We do our best to make sure that any information you give to us during virtual care visits is private and secure, but no video or audio tools are ever completely secure. There is an increased security risk that your health information may be intercepted or disclosed to third parties when using video or audio communications tools. To help us keep your information safe and secure, you can: 

  • Understand that video, emails, calls, or texts you may receive are not secure in the same way as a private appointment in an exam room. 
  • Use a private computer/device (i.e., not an employer's or third party's computer/device), secure accounts and a secure internet connection. For example, using a personal and encrypted email account is more secure than an unencrypted email account, and your access to the Internet on your home network will generally be more secure than an open guest Wi-Fi connection.

If you are concerned about using video or audio tools for virtual care, other arrangements can be made. However, please note that visiting a health care provider in person comes with a higher risk of coming into contact with COVID-19 and the possibility of spreading the virus.

By providing your information, you agree to let us collect, use, or disclose your personal health information through video or audio communications (while following applicable privacy laws) in order to provide you with care. In particular, the following means of electronic communication may be used (identify all that apply): email, videoconferencing (including Skype, Facetime, etc.), text messaging (including instant messaging), website/portal, other (specify).”

 
Documentation
When using an unregulated virtual care tool, you should record that verbal express consent was obtained in the patient’s permanent record. The following statement can be pasted in your encounter note:

“Informed verbal consent was obtained from this patient, to communicate and provide care using virtual care and other communication tools. This patient has been explained the risks related to unauthorized disclosure or interception of personal health information and steps they can take to help protect their information”
 
Resources
CPSA team members are available to speak with physicians who have questions or concerns. Please contact Chantelle.Dick@cpsa.ab.ca.

 

 

 

 

Find this and other resources to help you navigate the pandemic on our website, at www.cpsa.ca/resources-for-physicians-during-covid-19.

To do our part to keep Albertans safe during the COVID-19 pandemic, the team at CPSA is working remotely until further notice. If you need assistance, we are still available via phone and email during normal business hours.