Providing Physiotherapy Services by Telephone or Email

A physiotherapist owns a private practice that is a 45 minute drive from the provincial border. The physiotherapist’s website includes educational material related to sports injuries. The physiotherapist receives three messages related to physiotherapy practice.

A current patient has left a voice mail message with a status update and a number of questions about their self management.

A patient who was discharged two weeks ago says he is having a problem.

An email message asks if you would provide physiotherapy services over the internet to an athlete living outside the area who is skilled at managing his injuries but would benefit from professional advice.

Before responding to any of these messages, you want to be sure you understand your professional obligations related to the provision of physiotherapy services by telephone or email.

Response to Practice Scenario

While the College does not have a policy regarding the provision of physiotherapy services to patients over the telephone or by email, the performance expectations and regulatory obligations remain the same as when advising a patient face to face. The physiotherapist is accountable for all decisions and actions when practising as a physiotherapist. Good judgment related to individual circumstances is critical.

Issues for consideration in the scenario include:

Whether the specific questions of the patient are within the scope of practice of the physiotherapist;
The currency and accuracy of the physiotherapist’s information on the patient’s status; and
The confidence of the physiotherapist in the ability of the patient to act on his or her recommendations when they are provided by telephone or email.

Is it reasonable for a physiotherapist to provide telephone advice to a patient while they are on active treatment?

The physiotherapist must consider, on an individual basis, the context and the reason the patient is calling. The physiotherapist should analyze the new information provided during the conversation and determine which course of action is in the best interest of the patient. Depending on the significance of any new information, the physiotherapist may decide to schedule a reassessment. If there is no significant new information, the physiotherapist may address the patient’s concerns over the phone by providing reassurance and clarification. In either circumstance, the physiotherapist should document the date of the call, the nature of the request and the actions taken in the patient record.

Is it reasonable for a physiotherapist to provide telephone advice to a former patient after they have been discharged from physiotherapy service?

In considering this circumstance the context is very important as the physiotherapist no longer has a therapeutic relationship with the patient. Given the short time since discharge, and the ability of the physiotherapist to confirm with the patient that his or her status has not changed appreciably, it may be appropriate for the physiotherapist to provide limited advice over the telephone. The advice may be that a reassessment is required. Key elements of the interaction should be documented in the patient record.

By having educational material on the website is the physiotherapist providing physiotherapy services?

There is a fine but important line between providing general, educational information and practising the profession. It is important that physiotherapists set up their website in a way that someone visiting the website could not interpret the website as the physiotherapist engaging in telepractice or providing specific advice. Some factors to consider include:

The website should not offer individual assessment or a screening tool
Health information and any inclusion of exercises should be general and not altered or designed to reflect individual situations
Exercises should be offered as a possible option. A disclaimer with exercises can assist the public in under standing the limits of the information that is provided
Individuals should be cautioned to consult with a physician or another health professional who knows them well about determining whether the exercises may pose a personal risk to them

Is it reasonable for a physiotherapist to provide physiotherapy service over the internet?

As physiotherapists can practice only in a jurisdiction in which they are registered, one of the first questions related to an email request for treatment relates to identifying where the patient lives. If the patient resides in Ontario, jurisdiction is not an issue. If the patient resides outside Ontario, the physiotherapist must be registered with the regulatory College that governs that jurisdiction. If the patient is willing to drive to Ontario, jurisdiction is no longer an issue

In all circumstances, the physiotherapist is required to complete a traditional physiotherapeutic assessment prior to the development of a treatment plan. Depending on the circumstances, a variety of options may be possible. The patient and physiotherapist could engage in a combination of face-to-face interactions and internet communication using web-cam and or video conferencing. Despite the medium, the physiotherapist must meet the regulatory and professional obligations/standards of the profession as they relate to clinical services, privacy and record keeping for all patients under their care.

Can the physiotherapist charge for telephone and internet interactions?

A physiotherapist can charge a fee if the patient is informed of the fee for telephone or internet advice/consultation and that fee is reasonable for the service provided.

It is not the role of the College to recommend fee schedules or to advise the registrants on business decisions. The Standard for Practice: Fees & Billing describes expectations related to setting fees and billing for physiotherapy services.

Where can a physiotherapist access more information related to this topic?

National Initiative for Telehealth Framework of Guidelines (September 2003)

Canadian Alliance of Physiotherapy Regulators:

Considerations for Telepractice in Physical Therapy in Canada (September 2006)

Guideline for the Collection, Maintenance, Transmission, and Destruction of Electronic Health Information (November 2009)