On Sept 3, 2021 the Provincial Health Officer, Ministry of Health and the College of Physicians and Surgeons of BC jointly announced their position on the provision of in-person and virtual care. For in-person visits, they stated that 'All practitioners are expected to resume routine in-person visits based on clinical needs and patient preferences.'

For those who continue to offer a blend of in-person and virtual visits, the College of Physicians and Surgeons of BC (CPSBC) released its revised Virtual Care Practice Standard this past June, which will be in effect until 2024. 

The updates to this document are a result of recognizing the need for practice and policy improvements due to the recent accelerated reliance on virtual health solutions. These updates were informed from feedback gathered from 1,265 registrants (376 specialists and 889 family practitioners), 379 members of the public and numerous key health partners, with a focus on the appropriate use of virtual care.

“Virtual care is defined as any interaction between patients and registrants, occurring remotely, using any mode of communication or information technologies, with the aim of facilitating or maximizing the quality and effectiveness of patient care." ¹

There are some benefits that can be derived from use of virtual care has, such as enabling people with mobility issues or geographical barriers to access care. However, virtual care to those patients/clients who may not have access to technology, not well versed in digital literacy and/or who face other barriers to virtual communication. Some specialists, including emergency physicians, have raised concerns over the inappropriate use of virtual care to avoid or delegate the physical examination of patients. This behaviour may lead to delayed or missed diagnoses, and place an increased burden on Emergency Departments and specialists.

In light of these concerns, the College reminds registrants that appropriate use of virtual care is key, and includes in-person care. To ensure safe, effective and equitable services, virtual care must be integrated with comprehensive longitudinal primary care. Other expectations from the College include:

• Access to in-person and longitudinal care must be provided, as indicated and required by patients;
• If a registrant is not near the patient's location, they must have a formal affiliation with in-person providers in the patient's home community so that a timely in-person assessment can be arranged for when necessary.

 “If a primary care assessment of the patient presentation would normally include a physical examination before referral, the referring registrant must ensure that one is done. It is unacceptable to defer a physical examination because the virtual care medium does not allow for one." ²

In her message, College Registrar Dr. Heidi Oetter remarks that, “This is an important clarification intended to reduce fragmented care and inappropriate use of services, and emphasize the importance of using virtual care as a complementary component of the healthcare system that is integrated into comprehensive longitudinal primary care and specialty care." ³

For the full list of requirements for the appropriate provision of virtual care, as well as the requirements for cross-border virtual care to those residing in another province, territory or country, please refer to the updated Practice Standard.

You can also view a short video which outlines the changes to the standard, and a revised Virtual Care: What to Expect patient resource has been published.

Please direct any questions related to the revised Virtual Care practice standard to

communications@cpsbc.ca.

[1] Shaw J, Jamieson T, Agarwal P, et al. Virtual care policy recommendations for patient-centred primary care: findings of a consensus policy dialogue using a nominal group technique. J Telemed Telecare 2018;24(9):608-15. 

[2] https://www.cpsbc.ca/files/pdf/PSG-Virtual-Care.pdf

[3]​ https://www.cpsbc.ca/news/publications/college-connector/2021-V09-04/01​

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