Preamble
This standard replaces the Virtual Medicine Professional Standard adopted in February 2022.
The College of Physicians and Surgeons recognizes the importance of virtual medicine in providing access to care, especially for patients in remote and underserviced areas, patients with disabilities, patients in institutional settings, limited psychosocial supports or economic means, and in a pandemic or state of emergency. Physicians are encouraged to utilize access to virtual care when it is in the best interest of the patient.
Definitions
“Timely manner”: What is timely depends on the circumstances, the urgency of the presenting issue, and any potential risk to the patient if there is a delay in providing follow-up care. (moment opportun)
“Virtual care”: Any interaction between patients and physicians, occurring remotely using any mode of communication or information technologies and whose aim is to facilitate or maximize the quality and effectiveness of patient care. (soins virtuels)
Requirements
Providing virtual care does not alter the ethical, professional, and legal obligations of members to provide good medical care. Virtual care must adhere to the same standards as in-person care and, without limiting the generality of the preceding, includes meeting the standards set out in the Continuity of Care Professional Standard, the Episodic Care Professional Standard, the Patient Medical Record Professional Standard, and the Informed Consent Professional Standard.
Virtual care is to be used to optimize and complement in-person patient care. It is not acceptable to solely practice virtual medicine. If a physician provides virtual care, their practice must include timely in-person care when clinically indicated or requested by the patient. The physician must have a physical clinic or a formal arrangement with a physical clinic to provide this in-person care. The appropriate balance of virtual and in-person care will depend on the circumstances.
It is not appropriate to refer a patient to the emergency department or urgent care for a non-emergent issue in lieu of an in-person assessment. In addition, it is generally not appropriate for a physician to refer a patient to another health care facility, walk-in clinic or to a specialist in lieu of an in-person assessment.
A physician providing virtual care must:
1. Ensure they have sufficient knowledge, skill, judgment, and competency (including technological) to manage patients through virtual care,
2. Decide when it is appropriate to use virtual care in consultation with their patient by considering the well-being and benefit to their patient. In doing so, the physician should ensure virtual care allows for an appropriate assessment of the presenting problem. If it does not, the physician must recommend and offer a timely in-person assessment,
3. If the use of virtual care is deemed appropriate, use the most appropriate technology for the presenting problem,
4. Ensure the patient is not hindered by the technology and is able to meaningfully participate in the interaction,
5. Ensure they adhere to best practices for confidentiality and security, and have a suitable platform and infrastructure to engage in virtual care,
6. Take reasonable steps to protect Personal Health Information, including protection against theft, loss and unauthorized access, use and disclosure,
7. Ensure patients referred to a specialist are adequately investigated before referral; if a primary care assessment of the patient would normally include a physical examination before referral, the referring physician must ensure that one is done. It is not acceptable to defer a physical examination because virtual care does not allow for one, and
8. Have access to the patient’s medical record while providing care, unless emergency circumstances exist such that it is not possible to access the patient’s medical record.
Requirements to initiate a virtual care encounter
A physician initiating virtual care must:
1. Provide the patient with their name, location, and licensure status during the initial virtual care encounter,
2. Advise the patient that the virtual care encounter is confidential,
3. Take reasonable steps to confirm the patient’s identity and location during each virtual care encounter,
4. Ask the patient if the physical setting is appropriate, safe, private and secure given the context of the encounter and ensure consent to proceed,
5. Disclose the identities of all other participants involved in the virtual care encounter and ensure the patient consents to their participation,
6. Explain the appropriateness, limitations, and privacy risks related to virtual care in plain language during the initial visit,
7. Offer the patient the opportunity for in-person care if it is the patient’s preference.
Prescribing and authorizing
A physician providing virtual care must:
1. Conduct an assessment in accordance with the standard of care before prescribing or authorizing a drug, substance, or device,
2. Exercise caution when providing prescriptions or other treatment recommendations to patients they have not personally examined, and
3. Not prescribe controlled medications or cannabis to patients unless:
- they have previously examined the patient in person;
- they have a longitudinal treating relationship with the patient; or
- they are in direct communication with another regulated health professional who has examined the patient.
Licensing
The following licensing requirements apply to a physician practicing virtual care:
1. Physicians providing virtual care to New Brunswick patients located in New Brunswick must hold a valid licence with the College of Physicians and Surgeons of New Brunswick.
2. Notwithstanding clause (1), a physician who holds a valid licence in another Canadian province or territory, and who does not hold an active licence with the College of Physicians and Surgeons of New Brunswick, may provide virtual care to a patient located in New Brunswick in the following scenarios:
- To provide follow-up care or continuity of care where an established physician-patient relationship exists,or
- If the physician is providing care with a duly licensed New Brunswick physician who has in-person access to the patient.
3. New Brunswick physicians providing virtual care outside of New Brunswick are responsible for determining the licensing requirements of the Canadian province or territory or foreign jurisdiction in which the patient is located.
4. Physicians providing virtual care outside of New Brunswick are responsible for ensuring they have the appropriate liability coverage to provide care outside of the province.
Complaints
If the physician is registered with the College of Physicians and Surgeons of New Brunswick: the patient may file a complaint with the College. Since the College has jurisdiction over the physician, it can investigate and, if necessary, take the necessary measures to ensure public protection.
If the physician is registered in another province or territory, The College has no jurisdiction over the physician, and therefore cannot initiate an investigation. If the patient wishes to file a complaint (request an inquiry), he or she must do so in the country, state, province or territory where the physician is registered.
If the physician is registered in New Brunswick and in another province, territory or country: The College will discuss the investigation with the medical regulatory authority in the other province, territory or country where the physician is also registered, and will attempt to co-operate to allow the investigation to be primarily conducted by the most appropriate medical regulatory authority. The College may share information from the investigation to the extent it is legally permissible to do so.
ACKNOWLEDGEMENTS
The College acknowledges the assistance of the College of Physicians and Surgeons of Alberta, the College of Physicians and Surgeons of British Columbia, and the College of Physicians and Surgeons of Newfoundland in preparing this document.
APPROVALS
Approved by Council: October 24, 2024
Effective Date: January 6, 2025
Version: Original
Last Amended: N/A
REVIEW DATE:
January 2028
