How Can I Start Using Virtual Care?

Intro to Virtual Care
COVID-19 Communications Toolkit
Watch a Virtual Care ‘How To’ Webinar

The Ministry of Health (the Ministry) and the Ontario Medical Association have been working together to implement the 2021 Physician Services Agreement (PSA). K-codes that fund virtual care and other COVID-19-related physician funding have been extended to December 1, 2022. Please review InfoBulletin 220901 for details. Please review InfoBulletin 221002 for an update to New Virtual Care Funding Framework-Updated Schedule of Benefits and visit the OMA website for further details.

As per INFOBulletin #220901-Implementation of the new Virtual Care Funding Framework and INFOBulletin #221002-New Virtual Care Funding Framework-Updated Schedule of Benefits the new virtual care funding framework set out in the PSA will take effect on December 1, 2022, at which point video visits delivered through the Ontario Virtual Care Program (OVCP) will be transitioned into the OHIP insured framework in accordance with the pricing structure, rates and payment parameters outlined in the PSA.

Note: For clarity, OTN as a video platform, will remain in place.

Please visit the OMA’s website’s Billing and Compensation page for further details and the latest information on virtual care billing.

InfoBulletin 220901
InfoBulletin 221002
InfoBulletin 221102

Ontario Health (Digital Services) has created instructions for physicians on how to get ONE ID credentials to use provincial digital health systems such as the OTN virtual care tools. Physicians can visit the CPSO website to get ONE ID credentials or check to see if you already have them.

View the Instructions

On November 9, 2022, Ontario Health released new virtual care guidance materials for primary care clinicians. The ‘Clinically Appropriate Use of Virtual Care Guidance for Primary Care’ aims to help primary care clinicians feel supported in the decisions they make related to the planning and delivery of virtual care. This is ‘phase one’ of the virtual care guidance for primary care. More detailed virtual care guidance will be released in the future, including materials focused on other specialties and areas of care. The virtual care guidance for primary care materials were developed with a patient-centred care approach and informed by an expert panel of clinicians and patients. 

The virtual care guidance materials can be accessed at Ontariohealth.ca/virtualcareguidance. 

A French version of the virtual care guidance is also available at Ontariohealth.ca/fr/guidesoinsvirtuels.

Ontario Health (Quality) and OTN developed Adopting and Integrating Virtual Visits into Care: Draft Clinical Guidance for Health Care Providers in Ontario (March 2020). This guidance includes best practices for bringing virtual care into your clinic.

Unless you are using virtual care technologies where consent from the patient is handled at sign-up, you should ask patients for their consent. Please see the sections above (Statement to Obtain Consent to Initiate a Virtual Care Patient Encounter, Detailed Information to Make Available to Patients, and Paragraph to Make a Note in Your EMR)

Virtual Visits Verification Standard – Ontario Health A list to assist health service providers in the selection of virtual care solutions appropriate for clinical use.  

Note: There are other Virtual Visit Solutions available that physicians may prefer and choose to use, but these solutions have NOT been Verified by Ontario Health and physicians cannot bill for using them.

There are also other tools you can leverage for your practice to enhance the flow of patients, enable their care at home, or allow you to communicate with them.  Some are offered by EMR vendors and some are stand alone.  All the tools below have stated that they comply with Ontario’s Personal Health Information Protection Act (PHIPA), and consent for use is collected by the tool upon patient sign-up.

EMRs have other workflow assistance built into their core functionality that can assist with working virtually. Here is a sample of what they offer:

ABELMed EHR-EMR/PM (AbelSoft Inc.)

Secure Patient Messaging and Notifications

Physicians can communicate securely with patients registered on ABELMed Portal from the integrated Web Messaging inbox in ABELMed. Patients login to their ABELMed Portal account to view and send secure messages to their physician. Either party can initiate a messaging thread. Providers can also send regular email and text messages to individuals or groups of patients directly from ABELMed.

Digital Patient Forms and Documents

Providers can use ABELMed Portal to send electronic forms (e.g., COVID-19 screening form) to patients to complete and return online for automatic integration into ABELMed. Providers can easily and securely send patients electronic documents like lab requisitions, patient education information, exercise plans, etc.

Online Appointment Booking

Patients can request, reschedule or cancel appointments online based on your office policies using ABELMed’s patient portal. Office staff are required to approve any scheduling requests and changes.

Online Medications and Results

Patients can conveniently and securely view their medications, request renewals, and view lab results online via ABELMed’s patient portal.

ABELMed Mobile

When you need it, your valuable information is as close as your smartphone or tablet. ABELMed Mobile allows physicians to remotely view their scheduled appointments along with patient demographics, medications, and allergy information. 

Accuro® EMR (QHR Technologies Inc.)

Medeo

An integrated digital health patient engagement tool available as a mobile app or web-based tool. Medeo enables patients to use their mobile devices to securely message their provider, attend virtual calls, and book appointments with their providers using Accuro.

Online Booking

Gives your patients power over their own time while securely managing yours. Spend less time on the phone and more time running your practice.

Secure Patient Messaging

Message your patients from Accuro EMR. Share comments, results, and documents. Messaging is ideal for follow-ups, lab result reviews, and post-op consultations that don’t require an in-person visit. Only providers can initiate and close a message thread.

Secure Video Visits

Provide video appointments for chronic care, injury and pain management follow-ups, include other providers, and securely reduce barriers due to distance or patient mobility issues.

Avaros

Avaros Secure Video Chat

With Avaros Secure Video Chat, you can conduct video appointments with your patients directly from the EMR. You can also take notes in the patient’s chart and send relevant documents to the patient during the appointment.

Avaros Appointment Reminders

With Avaros, you can send Appointment Reminders to your patients via email or text. Patients will be able to confirm or cancel the appointment.

Avaros Secure Patient Messaging

Avaros’ Secure Patient Messaging feature allows users to send secure messages and documents to patients. Patients can securely retrieve documents and reply or confirm receipt of the message.

Avaros eForms Generator

Avaros’ eForms Generator allows users to quickly turn commonly used forms into auto-fill eForms.

EMR Advantage® (Canadian Health Systems Inc.)

Insig

A virtual care solution that directly integrates with EMR Advantage and allows a medical practice to offer phone, video and messaging appointment to patients.

IndiviCare

Communicate

This clinician controlled service allows you to send and receive secure electronic messages from your patients. All information is encrypted and secure at all times and is embedded in the patient’s chart. You can forward lab reports to your patient with the click of a button. If you wish to discuss the lab results with the patient electronically, the secure messaging application embeds this capability. Similarly, Communicate give your clinic the option to provide a patient-initiated secure messaging connection to a physician. 

Notify

Leveraging the power of Indivica’s network technology, IndiviNet, Notify is a native IndiviCare application that integrates appointment notifications and batch patient mailings into the standard IndiviCare EMR workflow. Notify allows, in the case of an outbreak such as COVID-19, an immediate bulk communications tool between the physician and their roster of patients.

Med Access EMR and PS Suite EMR (TELUS Health Solutions)

Digital patient forms

Enable patients to conveniently complete forms (including COVID-19 screening forms) online and update their personal information prior to their appointments to save time in the clinic.

EMR Mobile

Remotely connect to your EMR using a mobile device, anytime, anywhere. Access patient and clinic information, manage labs, document symptoms, and more.

MedDialog

Provider-to-provider communications: From your EMR, exchange and store unlimited digital and eFax communications with health care professionals outside your clinic for continuity of care.

Online Booking

This can be leveraged for booking multiple modes of appointments, including phone appointments with patients in a situation where in-clinic appointments are limited. Can be combined with COVID-19 bulletins and pre-screening forms.

Remote Patient Check-in

Empower patients to manage their own check-in, update information, and complete forms through a smartphone or kiosks to help limit contact with patients and staff members.

Secure Patient Messaging

Stay connected to patients with private messaging and patient broadcasting through a web-based, customizable portal.

TELUS EMR Virtual Visit

An easy-to-use, EMR-integrated feature that allows you to conduct virtual visits and live chat with patients – from your desktop EMR, smartphone or tablet. 

OSCAR McMaster – Professional Edition (WELL EMR Group Inc.)

At its core, OSCAR Professional McMaster Edition (OSCAR Pro), is the same OSCAR you know and use. It includes all the same great features you have grown accustomed to but with some added benefits. Namely, unparalleled support services, exceptional security and safety, a modernized interface, plus your choice of additional features designed to enhance your OSCAR experience even further. Click here to get started (Note links to Kai Innovations provider of OSCAR Pro).

VirtualClinic+ 

Integrates seamlessly with OSCAR. But can be used in conjunction with any EMR

Voice and Video PHIPA compliant telehealth platform for both practitioners with attached patients and those doing virtual walk-in. Can be used by physicians operating on any EMR platform but if you are a physician or clinic operating on an OSCAR EMR, VirtualClinic+ provides additional capabilities that allow you to operate your telehealth practice in a manner that is fully integrated with your EMR.

COVID-19 Tools For EMRs

It is the OMA’s position that doctor’s notes for clearance to return to work or school are not an appropriate use of primary care resources, especially while COVID-19 causes unprecedented strain on the health care system. Nevertheless, if you receive a request for a COVID-related doctor’s note, your obligations under the CPSO’s Third Party Reports Policy still apply. For more information see the OMA’s COVID-Related Doctor’s Notes Toolkit.

Taken from OMA webpage https://www.oma.org/member/practice-professional-support/covid-19/providing-care/covid-related-doctors-notes/

Sample language for request for exemption from COVID-19 vaccination.

The CPSO states that any notes exempting individuals from receiving the COVID-19 vaccine need to clearly specify the reason for the exemption. Where applicable, add any detail necessary given the circumstances relevant to the situation.

Directive 6 requires that the note specifies the time period of the exemption. The time period indicated should reflect the next expected reassessment of the condition, at which point the need for exemption can be re-evaluated. This could include pending evaluation by an allergist/immunologist or another specialist to determine if and how the individual may safely receive the vaccine. The time period indicated should also reflect whether the medical exemption is pending developments in medical knowledge (for example, if the exemption could be removed when more becomes known about myocarditis/pericarditis).

You may use the following sample language for requests that need a note for an exemption from the COVID-19 vaccination:

I attest that based on my knowledge of the patient and the information available to me, __________________ [PATIENT NAME] has a medical condition that prevents them from receiving a COVID-19 vaccine (check appropriate option):

•          Allergy to one or more of the vaccine ingredients, or severe allergic reaction or anaphylaxis following the first dose

•          Other serious adverse events following COVID-19 immunization

•          History of myocarditis (for individuals 12 to 17 years of age) or a diagnosis of myocarditis/pericarditis after dose 1 of Pfizer or Moderna

•          Actively receiving monoclonal antibody therapy or convalescent plasma therapy for the treatment or prevention of COVID-19

This exemption is valid for the following time frame:

Check one of two options:

•          Indefinitely

•          Time limited, until the following date: __________________

Accuro EMR Template
TELUS PS Suite EMR Stamp

Sample language for request for clearance to travel.

Where applicable, add any detail necessary given the circumstances relevant to the situation.

You may use the following sample language for requests for a note for clearance to travel. Note that the date of the test must be at least 11 days prior.

When you have proof of the patient’s COVID-19 infection within the past 3 months:

[DATE]

My patient, [INSERT NAME], tested positive for COVID-19 on [DATE OF TEST]. They have completed the isolation period required by Ontario provincial guidelines.

Based on my assessment today, the patient has no fever and their symptoms have been improving for at least 24 hours (48 hours for gastrointestinal symptoms).

[SIGNATURE]

Accuro EMR Template
TELUS PS Suite EMR Stamp

Sample language for exemption for wearing a mask in public

For requests for exemption from wearing a mask in public places, the following sample language may be used. Where applicable, add any detail necessary given the circumstances relevant to the situation.

I attest that based on my knowledge of the patient and the information available to me, [PATIENT NAME] has a condition that prevents him/her from wearing a mask.

Accuro EMR Template
TELUS PS Suite EMR Stamp

Sample language for clearance to return to work or school

The OMA has developed a patient attestation form for members to share with their patients. This form is adapted from a version previously shared by the OMA Pediatrics Section.

If a patient requests a clearance note, engage them in a conversation about the potential drawbacks of a doctor’s note for the purpose of clearance (the note will be vague, and the note is not covered as an insured service). The CPSO has confirmed that a self-attestation form may be offered to patients/parents as an option in lieu of a doctor’s note.  After the conversation, the patient may elect to use the self-attestation form instead of a note. This relieves you of your obligation under the CPSO’s Third Party Reports Policy.

However, if the patient still requests a doctor’s note over the attestation form, your obligation to prepare a note under the CPSO’s Third Party Reports Policy still applies.

If the patient prefers a note instead of the self-attestation form, the following sample language may be used. Where applicable, add any detail necessary given the circumstances relevant to the situation.

I attest that based on my knowledge of the patient and the information available to me, __________________ [PATIENT NAME] meets the Ontario Ministry of Health requirements1 for clearance to return to [work/school].

QHR Accuro EMR Template – Work / School
TELUS PS Suite EMR Stamp – Work / School

OntarioMD has collected some digital tools available in TELUS PS Suite, OSCAR, and Accuro EMRs designed to assist with COVID-19 documentation.  We’ve included instructions to help you access them within your EMR.

Accuro EMR COVID-19 Tools: Go to Form Publisher in Accuro to Access

How To Import Published Form

OSCAR EMR COVID-19 Tools:

Download Zip eForm
How To Import Zip eForm
COVID-19 Swab Lab Requisition

TELUS PS Suite EMR COVID-19 Tools:

Custom Forms Library
How To Import Custom Forms
Virtual Visit Stamp Example courtesy of Dr. Sharon Domb, Physician Peer Leader

OntarioMD is available to support you! Our Insights4Care (i4C) Advisory Service can assist you with redesigning office workflows to support virtual care, and to customize EMR tools to assist with managing the COVID-19 pandemic. To connect with a member of our staff, contact support@ontariomd.com

OMA Virtual Care (login required)

Information and resources to keep physicians safe, including an informational chart that explains the processes to assess patients with possible coronavirus symptoms.

OMA Business Continuity Planning Guide for Physicians (PDF)

Business continuity planning means thinking about and deciding how your medical practice or clinic will react and respond to different kinds of events (such as a natural disaster, pandemic, local events etc.). The purpose of this document is to support physicians with business continuity planning during COVID-19.

Ontario Ministry of Health

Information about the virus for providers and patients and how the province is responding.

Ontario eConsult Program

OTN and the eConsult Centre of Excellence have created a COVID-19 BASE™ managed eConsult specialty group for physicians and nurse practitioners to ask clinical questions to infectious disease specialists electronically and receive a response within days. The COVID-19 specialty group is accessed through the BASE™ managed specialty option and listed under Infectious Disease and Public Health. For non-patient specific questions please enter the patient information as:

  • First Name: COVID19
  • Last Name: COVID19
  • Date of Birth: 1900-01-01
  • Select OHIP number not available

Canadian Medical Association

The CMA is working with the Public Health Agency of Canada, provincial and territorial medical associations, and the Council of Chief Medical Officers of Health to share the most up-to-date and reliable COVID-19 resources with physicians and patients and to provide guidance on how to set up virtual care in your practice.

Centre for Effective Practice (CEP)

The Centre for Effective Practice is one of the largest independent knowledge translation organizations for primary care in Canada. CEP offers many useful resources such as Enhancing Management of Chronic Conditions Using Virtual Care During COVID-19, using Email and Secure Messaging, Telephone and Video, Screening for and Managing At-Risk Drinking and Alcohol Use Disorder (AUD) During COVID-19 and Virtual Care for Managing COPD.

Empower Health

National patient navigation health care options websites and mobile apps and information about all COVID-19 assessment centres. 

Insig

Free COVID screening questionnaires for use by any EMR user.

InTouch Health

Rated the #1 Virtual Care Platform for the third consecutive year by KLAS Research, InTouch Health offers an array of purpose-built telehealth devices and a scalable software platform for any use case and healthcare environment. In Canada, our solution provides a virtual-first strategy to rapidly respond, evaluate, and minimize the risk of spreading infectious diseases by keeping the healthy at home and virtualizing existing patient care. Just as we did for British Columbia’s Provincial Health Services Authority, we can deploy our cloud-based software quickly and cost effectively to enable end-to-end care, as well as a virtual COVID-19 questionnaire.

PageMe

PageMe is a PHIPA compliant mobile app that allows physicians to use their phones to text about patient care with colleagues and share images.  Old style pagers are antiquated, and regular texting or social media violate privacy statutes.  PageMe lets the user seamlessly communicate about patient care on their phone, but in a compliant manner.

Petal MD

Reduces the time of creating and maintaining schedules by up to 80%, plus swap shifts with your fellow physicians. Gain real-time access to the most up-to-date schedule. Share critical information with team members via secure messaging.

PrimaryON.ca

PrimaryON.ca identifies and helps provide solutions to the internal and external barriers that have historically limited the ability of FFS, FHG and CCM doctors in being able to actively engage in primary care planning, coordination and delivery. New resources include Safe Return to School Toolkit, Safely Restarting Your Primary Care Clinic, PPE resources, and more.

Public Health Ontario

Information about current outbreaks of infectious diseases in Ontario.

ShareSmart

ShareSmart is a free and secure clinical mobile application that enables healthcare professionals to use their own smartphones securely to take photos and discuss patient cases with colleagues. ShareSmart proudly meets and exceeds all local and global privacy regulations and guidelines making it the number one choice of doctors worldwide.

Telehealth Ontario

24-hour medical advice for patients by phone.

Virtual Care Resources for Canadian Physicians 

A province-by-province list of virtual care resources for physicians.

Virtual Care Tools Comparison

COVID-19 Guide
HRM COVID-19 Notifications FAQ
OLIS COVID-19 Test Results Reporting
Online Access to COVID-19 Lab Test Results for Health Care Providers

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