ACP Council approved the Standards of Practice for Virtual Care (SPVC) in June 2022. The standards were developed with the understanding that the ability of regulated members to routinely engage with patients in person is fundamental to the practice of pharmacy, and that regulated members work collaboratively with patients to mutually identify the patient’s needs, goals, and preferences.
Virtual care can be a valuable tool that can optimize and complement in-person care. Where in-person care is impossible or impractical, virtual care may be able to meet the needs of patients in remote or underserviced locations, as well as patients who are otherwise unable to obtain timely in-person care.
Virtual care includes any interaction between patients and regulated members that involves the provision of a professional service and occurs remotely using an enabling technology.
According to the SPVC, enabling technology is defined as any technology that permits communication between individuals in different locations, including through teleconferencing, video conferencing, email, or other internet-hosted service or application.
So, with that definition in mind, is the telephone considered enabling technology? The short answer is it depends on how the telephone is being used.
It is important to understand that the determination of whether virtual care is occurring is not based on the technology itself. It is based on the patient and the service being provided. When determining if an activity is virtual care, you need to consider what you are doing, not the technology used.
The Health Information Act requires that regulated members always ensure the patient’s privacy and that the confidentiality of their information is preserved. The SPVC provides further direction on how these requirements must be met when using enabling technologies for virtual care. One aspect of the SPVC requirement is that these technologies must be included on the privacy impact assessment submitted to the Office of the Information and Privacy Commissioner of Alberta.
Standard 7 of the SPVC requires the pharmacist to consider the limitations of any enabling technology used and ensure they are able to complete a thorough patient assessment using the chosen enabling technology. The pharmacist must use their judgement to determine which enabling technology best allows them to assess and appropriately communicate with each patient.
Examples
The provision of restricted activities and professional services using enabling technology is always considered virtual care. For example, when a pharmacist is assessing a patient in another location to dispense or prescribe medication or provide a clinical follow up, this would be virtual care regardless of whether the interaction is by telephone, videoconference, or some other enabling technology that has been accepted in the privacy impact assessment for the pharmacy.
On the other hand, when the telephone is used for non-clinical communication, it is not considered enabling technology. For example, if the pharmacy team phones a patient to schedule an in-person appointment, this would not be considered virtual care. Similarly, if the pharmacy used other enabling technology, including video conferencing or secure messaging, to communicate with patients about scheduling or other administrative tasks, this would not be considered virtual care.
Prescription refills
It is quite common for pharmacies to accept prescription refill requests via telephone—would this be considered virtual care? Once again, it depends. If a patient orders a prescription refill and, during a phone call, the pharmacist assesses the patient by asking clinical questions about side effects or efficacy, this is virtual care. On the other hand, if the pharmacist simply processes a phoned-in refill prescription, then conducts an assessment and has a dialogue with the patient when they arrive at the pharmacy in person, the call would not be considered virtual care. In both cases, the details of the assessment should be documented in the patient record. As outlined above, the regulated member must assess the type of service being provided to determine if it is virtual care.
It is important to note that the SPVC apply to the practice of each regulated member, regardless of their practice setting or its model of operations. Ensure you review the Standards to understand what virtual care is and how it can be used in your practice.
There are a number of requirements from the SPVC you must meet once you confirm that it is appropriate to provide virtual care over the telephone.
