Canadian Medical Association

Fitting virtual care into your practice workflow

For virtual visits to be effective, you must determine how to integrate them into your practice workflow.

There are two types of virtual care to consider:

  • messaging with patients through email or text
  • can fit easily into your practice as you and your staff can relay the messages

Note: Conventional email is not sufficiently private for exchanges with patients, which is why its use is prohibited by law/regulation in some jurisdictions.

  • meeting the patient for a “virtual” appointment at a pre-arranged time
  • the same process for in-person appointment bookings applies
  • may require support staff to help manage appointments

When setting a schedule to accommodate virtual visits, two key variables are:

  • the range of problems you assess and treat in your practice
  • the number of patient encounters booked well in advance, as opposed to same/next day

For example, a community family practice dealing with a wide range of problems and many same day bookings would have to mix virtual visits with in-person encounters. In comparison, a mental health practice could potentially make all their visits virtual.

Before introducing virtual visits, be sure to secure patient consent.

The most efficient way to educate patients is to direct them to a website with a clear explanation of the benefits, limitations and risks of virtual visits.

Technology you need to get started

The technology to provide virtual visits is widely available and creating a full-featured workstation is cost-effective. Here are some tips on how to find the right hardware and software:

The virtual visit and “webside” manner

Many of the visual cues that assure patients they’re in a professional doctor’s office are absent in virtual care. Here are some tips to ensure you engage with patients effectively:

What can be safely assessed and treated virtually?

Physician regulators all adhere to the same principle for virtual visits – a physician must not compromise the standard of care. If a patient seen virtually provides a history that requires an in-person examination, the physician must re-direct the patient for one.

The scope of virtual practice is presently limited to encounters that require only history, gross inspection and/or data that patients can gather with cameras and common devices (e.g., glucometers, home blood pressure machines, thermometers and scales).

  • mental health issues
  • skin problems
  • urinary and sinus infections
  • sexual health care
  • those monitored with home devices and/or lab tests
  • those that don’t require palpation or auscultation
  • Chest pain
  • Shortness of breath
  • Loss of neurologic function
  • Ear pain
  • Cough
  • Abdominal symptoms
  • Musculoskeletal injuries
  • Congestive heart failure

Note: Physical examinations can be waived if they do not serve the patient’s best interests, such as during contagious disease outbreaks.

The virtual visit – from beginning to end

There are several steps to follow with each and every visit to ensure optimal safety and efficiency.

  • Record/update patient demographic information
  • Verify patient’s health insurance card
  • Note reason for visit
  • Add any photos submitted in advance
  • Collect consent to use video conferencing for first-time patients

Note: These tasks can be delegated to office staff to complete before the video connection begins.

  • Authenticate the patient’s identity
  • Confirm the patient is in a province/territory where you hold a licence and billing number
  • Confirm they are in an appropriately private location. If they are, record their response. If not, ask them to change locations or reschedule the visit
  • Ask whether other people are present off camera
  • Disclose the risks of a virtual visit and obtain verbal consent. Record consent in the chart

  • Confirm the patient’s understanding of the assessment and plan
  • Send prescriptions to pharmacies
  • Send requisitions or referrals to the patient, or appropriate office/facility
  • Complete the encounter note for the virtual visit, following the same standards as for an in-person visit
  • Bill the government health plan the virtual visit fee code(s)
  • Complete, process and submit any necessary formsLa

Last updated May 14, 2020

For more detail on introducing virtual care intro your practice, download the Virtual Care Playbook.

Download the full Virtual Care Playbook

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