Providing virtual care (including telehealth)

Published March 2006, last revised March 2023, and currently in effect.

The following article applies in normal circumstances. For more information specific to the COVID-19 pandemic, see the CMPA COVID-19 Hub.

The following outlines the CMPA's principles of assistance for members whose practice includes virtual care. The CMPA considers "virtual care" to include any care provided when the physician and their patient are not physically together in the same room including video and phone consultations and discussions.

Eligibility for assistance

The CMPA's approach to assisting members with matters related to virtual care is consistent with its approach to assisting members in other matters: The CMPA will generally assist members in the event of medico-legal difficulties arising in Canada as a result of professional work done in Canada. The CMPA is not structured to assist with medico-legal problems and legal actions that arise outside of Canada or that result from care given outside of Canada.

When patients or physicians, or both, are temporarily outside of Canada, issues concerning continuity of care and physician obligations may arise. The CMPA recognizes such challenges and the benefits of using virtual technologies to bridge or mitigate interruptions in healthcare delivery. Under such circumstances, members would generally be eligible for CMPA assistance, provided the medico-legal problem or legal action is initiated in Canada.

Assistance scenarios

1. Patient and member in Canada
   A virtual care encounter occurs between a patient ordinarily resident in Canada and a CMPA member. The patient and the member are in Canada at the time of the encounter, although they may not necessarily be in the same province/territory. If the medico-legal problem or legal action is initiated in Canada, the member is generally eligible for CMPA assistance.
    
2. Patient and/or member temporarily outside Canada
   A virtual care encounter occurs between a patient and a CMPA member, both of whom are ordinarily residents of Canada (and have an established doctor-patient relationship). At the time of the encounter, the patient or the member, or both, are temporarily located outside of Canada. The CMPA will consider providing assistance with a medico-legal problem or legal action initiated in Canada, arising from urgent follow-up care to the existing patient.
    
3. Patient residing outside Canada
   A virtual care encounter occurs between a patient residing outside of Canada on a more permanent basis and a CMPA member located either in or outside Canada. In this scenario, the CMPA will generally not assist regardless of whether the medico-legal problem or legal action was initiated in Canada or elsewhere.
   
   
4. Member residing outside Canada. Members who are located outside of Canada on a more permanent basis are at greater risk of being sued in that foreign jurisdiction. Where a member is residing outside of Canada on a long-term basis and providing telehealth to patients in Canada, the member will not generally be eligible for assistance regardless of whether the medico-legal problem or legal action was initiated in Canada or elsewhere.

If a patient is outside of Canada temporarily (e.g. on vacation, temporary employment, or students pursuing studies abroad) and phones or emails the physician's office regarding a medical problem related to a condition the physician is managing, the member would generally be eligible for assistance, as long as the medico-legal problem or legal action is initiated in Canada. Given the potential limitations of such communication, it may be prudent to consider advising the patient to seek local follow-up.

If a member is temporarily outside of Canada for a purpose other than providing care (e.g. on vacation, at a conference), the member would generally be eligible for assistance arising from providing any urgent follow-up care to an existing patient, as long as the medico-legal problem or legal action is initiated in Canada. While CMPA assistance is always discretionary, the CMPA generally considers a member to be “temporarily outside Canada” when they are away without the intention to be engaged in clinical care and where they are away for days or a few weeks (less than 30 days).

Checklist

Before providing virtual care, consider the following:

• Have you complied with all applicable licensing requirements in the jurisdictions involved in the virtual care encounter? To ensure you are aware of applicable licensing requirements, consult your provincial/territorial regulatory authority (College). If you and the patient are located in different jurisdictions, you should also inquire with the College in the jurisdiction where the patient is located.
• Do you meet all applicable credentialing requirements established by the hospitals or clinics involved in the virtual care encounter?
• Do you meet all applicable technological standards established by the appropriate organizations?
• If the virtual care encounter is outside your province of work, have you indicated the proper province of work to the CMPA and are you paying the appropriate membership fee?
• If you live outside Canada on a more permanent basis, do you have professional liability protection for medico-legal problems and legal actions brought inside and outside of Canada?
• Have you communicated to your patients the conditions of your availability when either they or you are temporarily absent?

Other CMPA principles of assistance may affect eligibility for assistance with virtual care encounters

• Is the patient ordinarily a resident of Canada? If the patient is a non-resident, refer to the CMPA's principles of assistance when treating non-residents of Canada. In particular you should make reasonable attempts to have the patient sign the Governing Law and Jurisdiction Agreement.
• Is your virtual care practice in a clinic or facility? You should be familiar with the CMPA's principles of assistance described in Assistance to clinics and facilities.