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Telerehabilitation Resource Guide for Alberta Physiotherapists The remote deliv

Telerehabilitation Resource Guide for Alberta Physiotherapists The remote delivery of physiotherapy interventions mediated by communication technologies is an area of practice that is rapidly expanding. When providers engage in the provision of telerehabilitation services, they are expected to be aware of and comply with all regulatory expectations and legislation that applies to their practice and to deliver physiotherapy services that meet the same expectations for quality, competent care as services delivered in person. This resource was created to enable physiotherapists engaging in technology-mediated practice, whether within a single provincial jurisdiction or across jurisdictional borders, to do so safely and effectively. April 2018 2 Telerehabilitation Guide for Alberta Physiotherapists Physiotherapy Alberta This document is the result of a collaboration between the College of Physiotherapists of Manitoba and Physiotherapy Alberta – College + Association. Permission to reproduce, unaltered, in part or whole is granted. Please include a printed acknowledgement of the College of Physiotherapists of Manitoba and Physiotherapy Alberta – College + Association. This resource guide was developed to elaborate on telerehabilitation expectations identified in Standards of Practice and provides practical information to help ensure that the standards are met and that patients receive competent, ethical, quality physiotherapy care. Physiotherapy Alberta - College + Association 300, 10357 - 109 Street, Edmonton, Alberta T5J 1N3 T 780.438.0338 | TF 1.800.291.2782 | F 780.436.1908 info@physiotherapyalberta.ca | www.physiotherapyalberta.ca College of Physiotherapists of Manitoba 1465A Pembina Hwy, Winnipeg, Manitoba R3T 2C5 T 204.287-8502 | F 204.474.2506 info@manitobaphysio.com | www.manitobaphysio.com 3 Contents 4 Introduction 5 General Performance Expectations 6 Informed Consent 7 Privacy 8 Safety 9 Competence 10 Documentation 11 Quality Improvement and Evaluation 11 Fees and Billing 11 Supervision 12 Appendix A: Definitions 13 Appendix B: Other Considerations 14 References 15 Patient Information 4 Telerehabilitation Guide for Alberta Physiotherapists Physiotherapy Alberta The remote delivery of physiotherapy services using electronic communication technologies is becoming increasingly prevalent. The use of these technologies enables increased access to physiotherapy services for individuals living in rural and remote areas. It also enables access to providers with unique skills for all physiotherapy patients, regardless of where the patient or provider are physically located. The proportion of physiotherapists living in urban areas is greater than the proportion of the general population living in urban settings,1 and there are challenges in recruiting physiotherapists and other health professionals to work in rural and remote areas. The use of telerehabilitation provides an innovative means to match providers to patients and address this disparity. Introduction Broadly speaking, telerehabilitation refers to rehabilitation services that use any form of technology (including but not restricted to video conferencing, internet and telephone) as an alternative to face-to- face interventions.2 This use of electronically-mediated communication to deliver health services can occur over large or small distances3 or across jurisdictional borders.2,3 This resource is intended to assist physiotherapists to understand these expectations and develop policies and procedures to support quality, effective physiotherapy care using technology. This document should be read in conjunction with the Standards of Practice relevant to the physiotherapist’s practice. Physiotherapists who wish to deliver physiotherapy services across jurisdictional borders must be aware of all regulatory requirements related to the delivery of cross-border physiotherapy services, such as those established by the Canadian Alliance of Physiotherapy Regulators. When providers engage in the provision of telerehabilitation services, they are expected to be aware of and comply with all regulatory expectations and legislation that applies to their practice and to deliver physiotherapy services that meet the same expectations for quality, competent care as services delivered in person. 5 General Performance Expectations The physiotherapist: · · Complies with applicable regulatory requirements, including registration, insurance requirements, and competence. When providing telerehabilitation across borders, the physiotherapist must comply with the requirements of both the patient’s jurisdiction and the physiotherapist’s jurisdiction. · · Complies with expectations defined in the Standards of Practice and Code of Ethical Conduct. Interventions, referrals, or consultations delivered using telerehabilitation technologies are held to the same standards and expectations as those delivered in person. · · Uses their professional judgment to determine if telerehabilitation is appropriate, taking into consideration: – – Whether telerehabilitation is the most appropriate available method to deliver services. – – Whether a direct physical examination is required to complete the assessment and determine a physiotherapy diagnosis and treatment plan. – – The ability to deliver substantively similar care as physiotherapy delivered face-to-face. – – If patient factors such as physical, sensory, or cognitive deficits may impact the ability to deliver appropriate care via telerehabilitation.4 · · Ensures that telerehabilitation does not expose the patient to greater risk than other possible service delivery methods. This can include risks to the privacy of the patient’s health information or patient safety depending on the physical environment and context in which services are provided. · · Informs the patient of the process to follow if they have a concern or complaint about their physiotherapy care, including their ability to lodge a complaint in either or both jurisdictions if they choose (when services are provided across jurisdictional borders). 6 Telerehabilitation Guide for Alberta Physiotherapists Physiotherapy Alberta Informed Consent As with all physiotherapy services, for consent to be valid it must first be informed. In addition to the general requirements for consent outlined in the Standards of Practice and related documents, with regards to telerehabilitation the patient must have a clear understanding of the “limitations that telehealth services present as compared to in-person treatment”4 and “specific differences between in-house care and telehealth.”4 Patients must be aware of available treatment options, including options to receive in- person care and the unique risks and benefits that telerehabilitation provides. Informed Consent Expectations The physiotherapist: · · Augments routine informed consent processes as required to support telerehabilitation delivery. This may include express consent: – – To receive services via telerehabilitation rather than in person. – – For videotaping, recording or otherwise storing information and data from the telerehabilitation session. – – For the transmission of information via telerehabilitation technologies. – – For the participation of other health-care providers or the patient’s family in the provision of care. · · Develops policies and procedures to: – – Verify their identity to patients. – – Verify the identity of the patients whom they serve (to the extent possible). – – Document the verification policy and processes used. · · Develops policies and procedures to verify the identity of any third parties who may be observers or engaged in the delivery of care (i.e., family members, other regulated or unregulated health professionals, physiotherapy support staff) and obtains patient and provider consent for the presence of these individuals while delivering services. · · Informs patients of any limitations that telerehabilitation services impose on physiotherapy treatment, such as the inability to apply hands-on evaluation and treatment if applicable. · · Informs patients of the risks inherent in delivery of services using telerehabilitation, including risks to privacy of patient information and safeguards employed to address these risks. · · Considers the relevance and appropriateness of including a “hold harmless” clause for information lost due to technology failure3 in patient agreements, privacy statements, and consent documentation. 7 Privacy Physiotherapists are expected to practice in compliance with all legislative and regulatory requirements relevant to their practice; the practice of physiotherapy using telerehabilitation technologies is no exception. Physiotherapists need to be aware of and comply with the privacy legislation that is relevant to their practice. They also must be aware that when providing services to patients located in a different province or territory, the privacy legislation of both jurisdictions applies. In addition, the Personal Information Protection and Electronic Documents Act (PIPEDA) applies when transmitting information across provincial or territorial borders. Privacy Expectations The physiotherapist: · · Complies with all privacy and security requirements both during telerehabilitation sessions and when in contact with the patient through other electronic means, such as arranging appointments via email. · · Documents privacy and security measures used to protect the patient’s private information. · · Employs authentication and encryption technologies as well as secure transmission systems and storage mechanisms. · · Develops policies and practices to ensure that patient records cannot be accessed by unauthorized users, tampered with or destroyed, and are protected at both the originating and remote sites. · · Secures all physical devices used in telerehabilitation and when storing information related to telerehabilitation services. · · Is aware of any employer policies for privacy and security related to telerehabilitation. · · Maintains awareness of current and emerging risks to patient privacy inherent to telerehabilitation practice and employs technical, administrative, and physical controls to address these risks. 8 Telerehabilitation Guide for Alberta Physiotherapists Physiotherapy Alberta “Clients (patients) can expect to be safe in the care of the physiotherapist and in the practice environment.”5 That over-arching expectation seems obvious, however, the question of how to achieve this in a telerehabilitation practice is less so. The first step is to consider the various safety issues that are possible within this type of practice, which may include: · · Failure of the communication technologies used uploads/s1/ guide-telerehabilitation.pdf