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A Letter to Care Providers regarding Virtual Care
A written statement by UHN's Chief Medical Officer and Chief Medical Information Officer regarding the continued practice of virtual care at UHN.
October 18, 2021
Posted on behalf of Dr. Brian Hodges, Chief Medical Officer & Dr. Peter Rossos, Chief Medical Information Officer
Re: Virtual Care at UHN
Many of you have read the recent
joint position of the Chief Medical Officer of Health, Ministry of Health and the College of Physicians and Surgeons of Ontario which states that "in-person care can now be provided safely and appropriately", and that "it is expected that all physicians are providing in-person care based on clinical needs and patient preference".
Questions have been raised as to whether this will change our approach to in-person and virtual care at UHN – the answer is that it will not, because this joint position is consistent with our
Clinical Guiding Principles for Virtual Care. The UHN principles were developed and are maintained by UHN's Virtual Care Clinical Advisory Panel, which is composed of interprofessional care team members and UHN Patient Partners. In the creation of this "living" document we referenced and communicated with organizations including the CPSO and CMPA. The overarching clinical consideration is that
care providers should consult and practice within the virtual care standards or guidelines defined by regulatory bodies and/or associations of their profession.
The letter from the Chief Medical Officer of Health, Ministry of Health and the CPSO also states that "There are limits to what can be done virtually and the standard of care is often difficult to meet in a virtual care environment." If the selection criteria identified in the UHN Clinical Guiding Principles for Virtual Care are followed, physicians at UHN will most certainly be meeting the standard for patient care.
Since 2003 we have provided and pioneered virtual care to improve access, timeliness and safety for patients and caregivers requiring our expertise and services.
UHN continues to fully support the delivery of care through virtual means including by videoconference and telephone when it is in the best interests of patients, meets the standard of care, and is clinically safe. Through
Virtual Care at UHN we are dedicated to improving and innovating technologies and processes for seamless transitions between in-person and virtual care delivery.
Thank you for your ongoing commitment to A Healthier World in these challenging times. At UHN, the needs of patients come first, above all else.
Please feel free to contact us with questions, concerns, and suggestions.
Brian Hodges MD, PhD, FRCPCEVP Education and Chief Medical Officer, UHNProfessor, Faculty of Medicine, University of Toronto
Peter G. Rossos, MD, MBA, FRCP(C), FACP, CAGFChief Medical Information Officer, University Health NetworkProfessor, Faculty of Medicine, University of Toronto
Reason for Action: It was identified that TeamUHN requires a resource to support assessment of when virtual care is suitable for a patient. The Clinical Guiding Principles for Virtual Care were developed to meet this need.
Purpose: This document is a guide for TeamUHN, including care providers, administrative staff, researchers, and learners, to enhance the patient care experience through virtual care. It was developed and is maintained by UHN's Virtual Care Clinical Advisory Panel. Comments and suggestions are always welcomed (contact details below).
Consider clinical, psychosocial, socioeconomic, cultural and social identity needs and preferences when determining suitability for virtual care. As with any important decision, ensure that all available options are provided to and understood by patients, including research study participants, so that they may have the opportunity to consider their options and participate fully in shared decision-making.
Virtual care offers opportunity for innovation – allowing for alternate models of care, alleviating pressures to health care capacity, expansion of clinician scope, incorporating multidisciplinary care teams, and more.
Part 1: Clinical Considerations
Care providers should consult and practice within the virtual care standards or guidelines defined by regulatory bodies and/or associations of their profession.
Care providers who practice telemedicine must continue to meet the standard of care and the existing legal and professional obligations that apply to care that is provided in person.
Care providers (including learners) must be prepared with the necessary competencies and supports required to deliver virtual care (e.g., digital literacy, equipment, physical space).
Out of Province Patients
For some provinces, there are specific licensing requirements for care providers to complete. Please contact UHN's Virtual Care Team (VirtualCare@uhn.ca) to assist you with this process. In addition, physicians may also wish to consult the CPSO and CMPA for further information.
Access barriers must be considered in clinical decision making regarding virtual high risk prescribing. High risk prescribing should be practiced in environments where the goals of therapy are clear and patients receive ongoing interprofessional care (e.g., Palliative Care, Chronic Pain Management and Addiction Medicine).
Part 2: Patient Preference, Access & Barriers
Patient preference regarding virtual or in-person care must be always be considered. If the patient and provider decide on virtual care, it is important to also establish the most effective modality (e.g., telephone or videoconference). The following principles are intended to support patient-centred care and UHN's primary value of "the needs of patients come first" (see
UHN's Patient Declaration of Values).
Access and Equity
Results of a literature review (initiated April 2021) on access and equity barriers to participating in virtual care have been incorporated into this release of the Clinical Guiding Principles for Virtual Care. As a next step, peer-led focus groups are to be conducted in collaboration with UHN's Social Medicine Program and community partners, as a part of UHN's Outpatient Care Strategy. This document will be updated to include learnings from these engagements.
Please note, Virtual Care at UHN is working towards developing patient resources to build digital literacy skills and outline device requirements. Additional resources will be linked to this document as they become available.
Virtual Care at UHN is committed to working with patient partners, clinical teams, research teams, Social Medicine Program, and groups across UHN to creatively and effectively meet the evolving needs of our patients and TeamUHN.
We always welcome comments and suggestions to improve the Clinical Guiding Principles for Virtual Care.
Please contact Jennifer Catton (Director, Outpatient Strategy & Diagnostic Performance) at
Jennifer.Catton@uhn.ca or provide feedback via
Examples of urgent virtual care programs with appropriate expertise and supporting resources.
1 High risk prescribing: Prescribing of high-alert medications. High-alert medications are drugs that bear a heightened risk of causing significant patient harm when they are used in error. Harm is defined as a temporary or permanent impairment in body functions or structures. Includes mental, physical, sensory functions and pain. Institute for Safe Medication Practices (2018, 2005).