As a result of the ongoing COVID-19 pandemic, pharmacy professionals may increasingly choose to use virtual care to interact with patients for various reasons. Virtual care is an opportunity to provide care to patients through alternate means such as phone, email, and live video. The Guide to Providing Virtual Care to Patients in Pharmacy is intended to help pharmacy professionals provide virtual care to patients, however pharmacy professionals should be reminded that in doing so, they must continue to meet all applicable Standards of Practice, Code of Ethics, policies, guidelines, and legislative requirements relevant to practice. Additionally, pharmacy professionals are responsible for collecting, disclosing and disposing of personal health information in compliance with the Personal Health Information Protection Act (PHIPA), which also includes protecting this information from theft, loss and unauthorized use or disclosure.
When should I use virtual care?
Virtual care may be considered when it is not practical or advisable for the patient or the patient’s agent to receive, or for the pharmacy staff to provide, services at the pharmacy in person. Examples of situations where virtual care may be appropriate include:
- Counselling patients who are positive for COVID-19 or are in self-isolation
- Counselling elderly or vulnerable patients to support physical distancing
- Conducting a MedsCheck that is medically necessary for the patient’s understanding of their medications and to resolve urgent medication management issues (e.g., significant change to their medications after hospital discharge)
- Witnessing the ingestion of opioid agonist treatment
- Demonstrating the use of a medical device (e.g., glucometer)
What virtual care platforms are available?
There are many virtual care tools and platforms that can be used by pharmacy professionals to connect with patients.
Virtual platforms for healthcare services
These platforms are typically PHIPA compliant, and patient consent is usually collected by the virtual care platform when the patient registers for the service. Ultimately, it is the responsibility of the designated manager to ensure PHIPA compliance of the selected platform. Access to these platforms may require a subscription and may have an administrative cost for the pharmacy to register. Examples of these platforms include (but are not limited to):
Other Videoconferencing platforms
Other technologies, while more readily available, may not provide health system-level privacy and security compliance. When using these platforms, explicit verbal patient consent with respect to receiving care virtually and the privacy aspects of virtual care must be obtained and documented prior to the interaction.
Examples of these platforms include (but are not limited to):
- Skype and Teams by Microsoft
- FaceTime by Apple
- Zoom Basic
- Google Hangouts
- WhatsApp by Facebook
Since pharmacies may not have access to healthcare service platforms, the short-term use of other videoconferencing platforms during the COVID-19 pandemic may be appropriate if, in the professional judgement of the pharmacy professional, the benefits outweigh the risks. If choosing an unregulated platform, encrypted applications are preferred, and information transmitted should be kept to a minimum and should not include any unnecessary patient information.
Virtual care consultation tips
- When choosing a platform to provide virtual care, consider the following:
○ ease of use of the technology for yourself and patients
○ whether the technology maintains the privacy and security of data
- Consider developing a policy for your pharmacy outlining what technologies and equipment will be used, how privacy will be maintained, how patient consent will be obtained, documentation procedures, and what will be done in the event of a breach of confidentiality
- Obtain consent from the patient to receive care virtually and, if using an unregulated platform, consent to the privacy aspects of virtual care should also be obtained and documented
- Use the most up-to-date version of encrypted applications and two-factor authentication with strong passwords where possible, and always confirm the identity of the patient or their agent before providing virtual care
- Recommend that the patient use a private computer/device (i.e., not an employer's or third party's computer/device), a secure account, and a secure internet connection to protect their privacy, and remind them that, if at all possible, they should select a location where there is little to no opportunity for anyone to eavesdropping or overhear your interaction
- In advance of providing virtual care, prepare all relevant patient information required (e.g., current medication list, medications, demo devices, etc.) and test that the technology is working as expected (check connection and test the audio and video components)
- Schedule the appointment for a mutually convenient time and choose a quiet place where you will not be disturbed to conduct the consultation
- Acquire or verify the phone number for the patient before the consultation begins, and let the patient know that if you are disconnected during the consultation you will call them back
- During the consultation, focus on looking at the screen and not the camera
- In addition to obtaining patient consent, documentation should include the reason for providing virtual care services (e.g., “Due to COVID-19, patient in self-isolation”), the time, date, and technology used, and relevant information from the interaction
- If the provision of virtual care to patients is expected to be a continued practice, a Privacy Impact Assessment should be conducted to ensure these services are compliant with the Personal Health Information and Privacy Act (PHIPA)
List of Resources:
- Information and Privacy Commissioner of Ontario – A Guide to the Personal Health Information Protection Act, 2004
- Information and Privacy Commissioner of Ontario – Resources for Health Organizations
- Pharmacy5in5 – Pradeep & the Virtual Consults
- OntarioMD – Virtual Care and the 2019 Novel Coronavirus (COVID-19)
- Institute for Safe Medication Practices Canada – Virtual Medication History Interviews and Discharge Education
- University of Oxford – Video consultations: a guide for practice