This article originally appeared in the May/June 2020 issue of the Ontario Medical Review magazine.
Supporting privacy and security
COVID-19 and the urgent need for social and physical distancing have required the health care system to pivot and quickly adapt to current realities. In particular, Ontario patients and their doctors and other health care providers have had to find new opportunities and technologies to engage in safe and efficient care delivery.
Virtual care and associated tools have become a key path to dealing with many patient questions and concerns. Virtual care provides an opportunity to triage these questions, and in appropriate cases, can be used to provide support and treatment recommendations, including prescriptions.
The need for the almost overnight adoption of virtual care tools raises critical usability, privacy and security issues for patients and health care providers. OntarioMD, together with the OMA, has been working closely with frontline physicians, technology vendors and health system partners including the Ministry of Health, Ontario Health, the College of Physicians and Surgeons of Ontario (CPSO), and the Canadian Medical Protective Association (CMPA) to provide guidance and leadership in this evolving landscape.
Virtual care involves the provision of health care through live interactions with physicians using the telephone or a variety of audio or video teleconferencing applications (apps). These health care apps can be provided directly through a physician’s electronic medical record (EMR) by vendors or may be separate and non-specialized. If they are provided by an EMR vendor, there may be additional benefits, such as the ability to interface with the patient record in the EMR. In other cases, virtual care tools can be provided by other platforms commonly used to communicate via video or audio conferencing.
Health care providers and their patients can choose the method of virtual interaction that best meets their needs based on the circumstances. Also, there is nothing requiring the use of a face-to-face app at all; the telephone can always be used. Health care providers should in all cases look for virtual care tools that can help ensure a private and safe patient interaction, and take steps that are reasonable in these exceptional circumstances to work within as privacy-protective an environment as possible.
Whether any health care interaction is secure depends on a number of physical, administrative and technical controls. Context matters. A telephone call from a landline telephone in a closed room between a physician and a patient can be more secure than a meeting in a hallway. There are steps that health care providers and patients can take to optimize privacy and security. This includes participating in a virtual care interaction in a private setting and using an encrypted virtual care platform (some are provided directly from an EMR), if possible. OntarioMD and the OMA have prepared suggested language and templates that health care providers can use to support their patient interactions and to help patients better implement privacy and security safeguards. These suggestions can be found in the Consent for Virtual Care document on the OMA’s virtual care web page.
Yes, the CPSO recognizes virtual care and states on its website that the “use of virtual care has rapidly been rolled out across the province.” The CPSO also has general policies around the use of virtual care, as well as specific guidance during the COVID-19 emergency. The provincial government has introduced a temporary fee code change that allows physicians to more flexibly bill for virtual visits, and more information is available on the OMA’s virtual care web page.
The Ontario College of Pharmacists and the CPSO also established a policy allowing the use of email, if necessary, for prescriptions during the exceptional circumstances of this emergency. Details can be found in the COVID-19 FAQ on the CPSO website. Using established secure channels for prescriptions where possible is recommended.
Yes, virtual visits are covered. 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 while email and texts to patients may also be useful for care, they are not discretely funded.
OntarioMD and the OMA are committed to helping raise awareness among physicians and their practices about tools that they might consider in supporting their patient community during the COVID-19 pandemic and beyond. While OntarioMD has not evaluated these tools and does not endorse one tool over another, we believe there is value in curating a list of tools to which we have visibility based on our relationships with various provincial and national stakeholders. This list is available at OntarioMD News and is updated regularly. If you have a product-specific question, please contact the vendor directly.
Health care providers should ask patients for their consent before engaging in virtual care. In some tools, consent from the patient is handled at sign-up. Where consent is not managed directly in the tool, OntarioMD and OMA have worked together to provide a statement to provide to patients for initiation of a virtual care encounter. A suggested consent statement and a template note that can be pasted in the EMR indicating that consent was obtained from the patient for the use of virtual care tools is also provided. This information is available on the OntarioMD website and the OMA’s virtual care web page.
The Information and Privacy Commissioner of Ontario (IPC) has published a “Notice to the Public” addressing privacy matters during the exceptional circumstances of the emergency. Specifically, the IPC has acknowledged the need for the health sector to use phone, text, email, and other messaging services including the use of technologies not normally used for business during the crisis.
OntarioMD held several virtual care webinars for family physicians and specialists during which physicians could learn about the new billing codes and examples of virtual care tools used by some of OntarioMD’s Physician Peer Leaders. Recordings of the webinars are available at OntarioMD.
Peer Leaders are expert EMR users and early adopters of virtual care tools. They are available to guide you through the options and answer your questions.
Contact peer.leader.program@ontariomd.com to connect to a Peer Leader. OntarioMD field teams are also in your area to help you make sense of virtual care tools. You can get in touch with your local OntarioMD Practice Advisor wherever you are in Ontario by contacting support@ontariomd.com.
Supporting physicians to use virtual care tools has been a component of OntarioMD’s mandate since its success in guiding Ontario physicians to use EMRs. As physicians began to use additional digital health tools integrated with their EMRs, OntarioMD has fulfilled the need for comprehensive Privacy and Security Training through a Module that can be completed at any time, from anywhere that health care providers and their staff can access the Internet. The need for this type of training is more important than ever. The training is complimentary, and accessible on the OntarioMD website link. OntarioMD also offers a range of bulletins and information on keeping patient data secure for you and your staff to review.
The Privacy and Security Training Module is accredited by the College of Family Physicians of Canada’s Ontario Chapter, and family physicians who complete it are entitled to claim two Mainpro+ credits.
The best approach to strong privacy and security practices is to have a plan to regularly review your practice technology to ensure it is up-to-date and secure. In particular, verifying and testing your recovery and back-up can be extremely helpful.
In addition to taking advantage of the OMA and OntarioMD’s many resources, products and knowledge, we invite you to connect with us anytime at support@ontariomd.com.