WHAT CAN I DO?

Screening:

  • Use EMR-enabled tools to
    •        Assess illness (templated forms)
    •        Triage for care or screening (questionnaires)
    •        Clinical notes to record virtual visits
    •        Direct patients quickly to
      •             • Self care
      •             • In-office visit
      •             • Screening/testing facilities
      •             • Acute care facility (ER) when required

Care for patients with suspected COVID-19:

  • Use virtual tools to keep contact with patients who have symptoms and who you are monitoring
  • Reassess patients virtually if worsening

Care for regular patients:

  • Use virtual care tools to avoid unnecessary trips to the office
  • Manage chronic disease
  • Managing other acute illness that may not require a physical exam

There are many virtual tools that can be used to help you provide the best care during outbreaks of infectious diseases or at any other time.

Any direct-to-patient telephone, telemedicine and video calling platforms can now be used as the work is remunerated with the new fee codes, rather than the platform you choose. This allows rapid and wide scaling of care that works best in your area.  When choosing, consider how easy the technology is for you to use, how easy it is for patients to use, how the technology can help you keep patient information private and secure, and that you must record the work in your medical record. Additional technical guidance may be provided by the Ministry to inform technology selection and this page will be updated to point to the information. Consider the right type of contact, for the right patient, at the right time, for the right problem. Video conferencing and phone calls are payable under the new fee codes, but email and texts to patients may also be useful for care, even if not discretely funded.

Unless you are using virtual care technologies where consent from the patient is handled at sign-up, you should ask patients for their consent.

Information vetted by OMA and OntarioMD legal teams and the CMPA has been created to make this easier. OMA Legal has prepared a short paragraph statement and information to provide to patients to initiate a virtual care patient encounter which has also been vetted by the CMPA. Click the blue bar immediately below to view the statement.

Statement to Obtain Consent to Initiate a Virtual Care Patient Encounter

Virtual Care has some inherent privacy and security risks that your health information may be intercepted or unintentionally disclosed. We want to make sure you understand this before we proceed. In order to improve privacy and confidentiality, you should also take steps to participate in Virtual Care in a private setting, use an encrypted email service if available, and you should not use an employer’s or someone else’s computer/device as they may be able to access your information.

If you want more information, please check the [website/confirmation email/etc.]. If it is determined you require a physical exam you may still need to be assessed in person. You should also understand that virtual care is not a substitute for attending the Emergency Department if urgent care is needed. If you continue, you consent to the use of electronic communication to provide you with care, are you ok to continue?

Patients need only consent once for ongoing virtual care. This consent can be obtained by administrative staff in advance of the encounter.

Note: If Prescriptions are to be Sent by Email

CPSO, CNO, and OCP have made an exception to allow the use unencrypted email for the purpose of sending prescriptions to a pharmacist during the current declared emergency. If you wish to use unencrypted email to send prescriptions to a pharmacist, then you must obtain the consent of the patient for this purpose that explains unencrypted email may not be secure.

You might ask:

“Do you consent, understanding that unencrypted email carries an inherent risk of disclosure to third parties, to the use of such email for the purpose of communicating your prescription with a pharmacist?”

You must also add a sentence to the record of consent in the EMR (below) indicating:

The patient’s consent was obtained to use unencrypted email for the purpose of communicating their prescription with a pharmacist.

More information to help support the consent process is available on the OMA’s virtual care page. We also suggest posting the following information to your website, in your office, or making it available to patients and adapting it for when you explain it to them. Click the blue bar immediately below to view this information:

Detailed Information to Make Available to Patients

The more detailed information below is included for your use and must be made available to patients:

Our clinic 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 electronic communications for some patient visits rather than asking all patients to come into our office. Some of these technologies are provided by the Province. Others have been provided by vendors such as Google, or Apple to help make discussions with your care provider as easy as possible during these difficult times. Some health concerns can be addressed with virtual care alone, but in some cases your doctor may ask you to visit a hospital or other health-care facility, if necessary, for a physical examination.

We do our best to make sure that any information you give to us during virtual care visits is private and secure, but no electronic communications tools (such as audio, video, email, text) are ever completely secure. There is an increased security risk that your health information may be intercepted or disclosed to third parties when using such electronic communications tools. To help us keep your information safe and secure, you can:

• Understand that electronic communications (such as audio, video, email, text) you 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.

You should also understand that virtual care is not a substitute for in-person communication or clinical examinations, where appropriate, or for going to an Emergency Department when needed (including for any urgent care that may be required).

If you are concerned about using electronic communications for virtual care, you can ask our office to attempt to arrange a potential alternative. 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, audio, email, or text communications (while following applicable privacy laws) to provide you with care. In particular, the following means of electronic communication may be used [(identify all that apply): audio, video (including Skype, Facetime, etc.), email, text, etc.].

You should also record that verbal express consent was obtained when using a product that does not have explicit health care consent.

Paragraph to Make a Note in Your EMR

The following paragraph was constructed for inserting into an EMR during (or in advance) of a virtual care encounter:

Informed consent was obtained from this patient to communicate and provide care using virtual care electronic communications tools. [(If you are using email for prescriptions) The patient’s consent was obtained to use unencrypted email for the purpose of communicating their prescription with a pharmacist.] 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. We have discussed that care provided through electronic communication cannot replace the need for physical examination or an in person visit for some disorders or urgent problems and patient understands the need to seek urgent care in an Emergency Department as necessary.

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