The rise of telemedicine and the regulatory regimes that govern it

By Jennifer Pritchett, Associate Editor

With the growth of telemedicine, hospitals and other health-care organizations should have policies in place to outline how best to use it to ensure they meet their regulatory responsibilities, says Toronto health lawyer Michael Gleeson.

“These policies should outline who can provide it and when, and what sort of technology they need to have in place in accordance with their standards of care and privacy responsibilities,” he tells

Gleeson, a partner with DDO Health Law, says Ontario health professionals are more often than ever before using telecommunications and it’s important they — and the organizations in which they work — understand the regulatory requirements around it.

“If you are providing health care within Ontario but to patients outside the province, there are regulatory regimes that govern that,” he says.

“There are questions such as, ‘Do you need to be registered in the province where the patient is or where the physician is operating from?’ Right now, there is no uniform regulation for how that’s dealt with in Canada. It varies from province to province, and if you’re a physician providing telemedicine, you need to be aware of that to ensure you are within the guidelines.”

Gleeson says there are also issues around the management of patient records, insurance when it comes to physicians giving advice, and the standard of care.

“The standard of care provided in telemedicine needs to be the same standard as when the patient is face-to-face with the physician,” he says.

“Depending on the patient’s illness, it may not be appropriate to provide telemedicine. In some cases, telemedicine isn’t appropriate if the physician isn’t able to get all of the sensory cues that they would have during an in-person meeting with the patient. Those sensory cues are often essential for a proper diagnosis.”

Gleeson explains telehealth started out as either a telephone conversation or videoconference between a patient and a health-care provider, usually a physician or a nurse, to reach people in remote areas of the province.

“It has been used so that people in northern Ontario, for instance, can access specialists or a general practitioner without travelling long distances,” he says. “They rely on a video link to receive treatment remotely.”

Gleeson says the technology continues to expand and telemedicine is not only being utilized for people in remote areas.

“It’s used for people in cities who have mobility issues and can’t easily get to a health-care provider,” he says. “Technology allows them to speak with, or conference, with a health-care provider without having to visit a clinic.

"Health-care providers also use it for consultations with other health-care professionals, so rather than having to schedule a time with a specialist, which can be difficult to do, the primary physician can contact them via videoconference and can send pictures or diagnostic tests to do the consult that way.”

Telemedicine is becoming a popular tool for educating health-care providers.

“Health-care providers can get up-to-date information and continuing education from experts within a particular field without having to travel to a major city,” he says. “Previously, this type of instruction would involve travel to attend a conference. Now, they can simply log-on and receive training through teleconference.

“Telemedicine is facilitating education and patient care.”

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