Providing virtual care

The College has received questions from kinesiologists about whether providing services virtually is an appropriate alternative to in-person service during the COVID-19 pandemic. Please see below for a series of FAQs on this topic. If you have specific questions, please contact the College at info@coko.ca.

What should I consider before providing services virtually?

Here are important factors to consider before making decisions about offering virtual care:

  • Is it clinically appropriate based on each patient's/client’s needs or is an in-person visit required?
  • Are there any physical, cognitive or sensory deficits that may make virtual practice unsafe or ineffective for a particular patient/client?
  • Are you able to protect the safety of your patient’s/client’s personal health information? (consider your and their location and the technology itself- make sure it is PHIPA compliant).
  • Do you have a plan in place to deal with potential adverse events such as patient/client medical emergencies, failure of the communication technology or environmental hazards? 

Is consent required for virtual service or is consent implied during a pandemic?

Yes. Consent to virtual service is required and it is not implied. The consent conversation should at minimum cover the same basic information, whether the service is provided in-person or virtually. The consent conversation that takes place with a patient/client should discuss the benefits, risks, alternatives and possible outcomes should the patient/client not receive the service.

You must get the patient's/client's consent to involve someone else in their care, like an assistant or student. The patient/client must also be informed that they can refuse service at any point during the session.

Virtual service does introduce some new elements to the consent conversation, such as:

  • It might become too complicated or difficult to complete the assessment or treatment and either party can stop the session and discuss how to move forward.
  • The potential benefits, constraints and risks of using technology. Things like privacy, security and ability to communicate during a virtual session.
  • The patient/client should be reminded that they can ask you questions at any time.

You should summarize the discussion at the end of the session and document this in the patient/client record, including the patient’s/client's consent.

Some organizations and practitioners have developed a consent to virtual/remote care template. In the absence of such a written form, obtain verbal consent and document the consent discussion in the patient/client record.

Consent example: CMPA- Consent to use electronic communications

View the College's Practice Standard- Consent and the Practice Guideline- Consent.

What should I do about invoices for virtual services? 

Invoices should be an accurate representation of the service provided to the patient/client. If the service was provided virtually, it should say this on the invoice. If you are unable to enter the fact that it was a virtual session in an electronic invoice because of the format, it should be added as a note in the patient/client record.

View the College's Practice Standard- Fees and Billing and the Practice Guideline- Fees and Billing.

What risks should we consider when using virtual platforms?

You are reminded of your professional and legal obligations related to virtual care including (but not limited to) minimizing the risks of virtual care:

  • Obtaining informed consent (documented) to the virtual encounter (e.g. risk, benefits, and alternatives with virtual care and the type of technology used);
  • Meeting privacy and confidentiality requirements (e.g. physical and technical safeguards to protect personal health information and not using platforms that store recording encounters on the cloud or ‘offsite’ without College or employer approval);
  • Maintaining proper and secure documentation and patient/client records (note: the same standards for documentation apply to both in-person and virtual care encounters);
  • Ensuring positive patient/client and substitute decision maker identification (e.g. defined by your local protocol/guidelines);
  • Complying with  your duty of care responsibilities (e.g. providing the patient/client with adequate/appropriate information, use of language and cultural interpreters, timely consultations, etc.);
  • Ensuring program and platform suitability (e.g. pros/cons of the platform, suitability to the patient/client and practitioner needs).
If you are using Zoom, please read an advisory on Zoom released by the Ontario Government on April 9, 2020

Does the College recommend any resources for virtual platforms?

Several resources have been published setting out guidelines and strategies for the implementation and use of virtual care. A few examples are provided below: 

What should we be doing to prevent privacy and cyber risks during the current pandemic?

Where possible, minimize the exchange of personal health information and/or sensitive information through unencrypted channels.

  • There has been an increase in the number of SARS-CoV-2 related malicious emails. There has also been an increase in website registrations - some of those could be malicious.
  • Remain vigilant in identifying SARS-CoV-2 themed spam/phishing emails and malicious websites.
  • If applicable, collaborate with your organization’s information technology/infrastructure team to identify, report, and block malicious email and website domains. Information technology/infrastructure teams are reminded to stay informed of latest emerging threats. Where possible, keep up to date with security patches and upgrades.
Cyber alert example - https://cyber.gc.ca/en/alerts/cyber-threats-canadian-health-organizations

Can I provide services virtually out-of-province during the pandemic?

Yes. The considerations noted in the above FAQs still apply. If you are providing services virtually out of province, please also ensure that you are complying with any applicable regulations or rules of that province (e.g. around privacy and confidentiality).