Expectations Regarding Tele-rehabilitation Based on Existing College of Physiotherapists of Ontario Standards and Rules

What is Tele-rehabilitation?

Tele-rehabilitation, also known as virtual care, is the delivery of professional physiotherapy services at a distance, using telecommunications technology as the service delivery medium.

Tele-rehabilitation relates to all aspects of patient care including the patient interview, physical assessment and diagnosis, treatment, maintenance activities, consultation, education, and training. It can include the use of media such as videoconferencing, email, apps, web-based communication, and wearable technology. Physiotherapist assistants may or may not be present with the patient.

Tele-rehabilitation is an alternate mode of service delivery of traditional rehabilitation services and as such, the practice of tele-rehabilitation does not remove or alter any existing responsibilities for the provider.

Providers must adhere to all existing practice requirements, including the scope of practice of the profession, the standards of professional practice, the code of ethics, as well as any provincial and federal laws that guide practice.

Registration Requirements

• Physiotherapists must be registered to practice in Ontario to provide tele-rehabilitation to patients in Ontario.
  
  
• Physiotherapists assessing or treating patients in another jurisdiction must be registered to practice in that jurisdiction.

Competence 

• Physiotherapists who provide tele-rehabilitation must ensure they have the knowledge, skills, abilities and judgment to safely and effectively provide care remotely.

Standards and Expectations

• All relevant standards, rules and legislation apply to physiotherapists’ performance of tele-rehabilitation
  

  This means:

  • The College’s standards of practice apply to the practice of tele-rehabilitation.
  • The Colleges’ code of ethics applies to the practice of tele-rehabilitation.
  • All relevant legislation applies to the practice of tele-rehabilitation.

• Physiotherapists must use their professional judgement to determine:
  • Whether tele-rehabilitation is the most appropriate method to deliver services considering the circumstances.
  • Whether a direct physical examination is required to complete the assessment and determine a physiotherapy diagnosis and treatment plan.
  • Whether they have the ability to deliver substantively similar care as physiotherapy delivered face-to-face.
  • Whether patient factors such as physical, sensory, or cognitive deficits may impact the ability to deliver appropriate care through telerehabilitation.
• Physiotherapists must ensure that tele-rehabilitation does not expose the patient to greater risk than other possible service delivery methods.
  
  
• Record keeping must indicate if the physiotherapy session was provided through tele-rehabilitation.
  
  
• Physiotherapists must be aware of and comply with the privacy legislation relevant to tele-rehabilitation practice, including the Personal Health Information Protection Act.
  
  
• Physiotherapists are accountable for the privacy and security of patients’ health information that is transmitted for the purpose of tele-rehabilitation.
  
  
• Physiotherapists must obtain informed consent for tele-rehabilitation.
  
  
• The consent conversation must include all elements of consent according the Health Care Consent Act.
  
  
• Physiotherapists must ensure clear communication in tele-rehabilitation.
  
  
• Physiotherapists must manage the additional technology considerations associated with tele-rehabilitation such as security, data storage and technical trouble shooting.
  
  
• Physiotherapists must have an adverse event plan in place should a patient experience an emergency during a tele-rehabilitation physiotherapy session.

• Liability insurance requirements apply in tele-rehabilitation.
  
  
• Physiotherapists should check with their insurance providers if treating patients out of province to ensure coverage.

Fees and Billing

• Physiotherapists who provide tele-rehabilitation should ensure that their invoices are clear:
  • that the care being billed for was provided through tele-rehabilitation
  • who provided the care.
• Physiotherapists should discuss fees and payment options with the patient.
  
  
• Physiotherapists should advise their patients to confirm with their insurer whether tele-rehabilitation sessions are covered.   

Government Advice & Direction on Tele-rehabilitation

The Ontario government recently directed that all health system employers should consider a review of their services and practices to identify how they can provide services to patient groups virtually or remotely.

References:

See Health Worker Illness and Return to Work  (page 2 & 3, section Practice Social Distancing and Facilitate Virtual Arrangements)

Primary Care Providers in a Community Setting (This applies to physiotherapists as confirmed by the Ministry of Health.)