Regulatory Guidance

 Telemedicine - Providing Naturopathic Care at a Distance

While more and more Naturopathic Doctors offer patient consultations via Skype as a convenience and patients are requesting this type of visit there are a number of factors to consider before providing a visit via telemedicine.

Telemedicine is the provision of naturopathic care to a patient at a distance using information and communication technologies. While these technologies are expanding and evolving, common examples include telephones, emails and video/audio conferencing such as Skype.

As in any practice situation the member must comply with all regulations and standards of practice of the College of Naturopaths of Ontario. Just because the visit does not occur with the patient in the ND's office, it does not mean it can be done without ensuring all requirements are met. For example, the naturopathic doctor-patient relationship must exist, informed consent must be obtained and proper records kept.

Necessary questions to ask yourself when considering providing patient care via telemedicine are as follows:

Is this in the best interest of the patient?

Naturopathic Doctors are to use their professional judgment to consider the circumstances of each patient and each visit and decide if the use of telemedicine is in the patient's best interest. The patient's condition, their individual needs and the appropriate assessment and treatment are to be considered, not just the convenience and time-effectiveness of conducting such consultations.

Is the patient's privacy protected?

The member always has the responsibility to ensure that a patient's health information is kept private and confidential in accordance with the Personal Health Information Protection Act (PHIPA). This includes ensuring that reasonable security protocols are in place with respect to the technology being used. The use of cell phones and apps may allow for accidental access to the patient's information by unauthorized third parties. While the patient may consent to the use of such technology, the ND still has the requirement to ensure privacy. The office of the Information and Privacy Commissioner of Ontario can provide information on the technologies and accredited networks that meet the necessary security standards.

Also consider the physical setting of the patient and whether or not they are in a private place rather than sitting in a public space.

What are the legal requirements in the jurisdiction, if the patient is located outside of Ontario?

When providing care to a patient who is located in another province, territory or country via telemedicine, the member must comply with the licensing requirements of that jurisdiction. This may require that the ND hold the appropriate license/registration with the naturopathic or medical regulatory authority of the jurisdiction in which they are practicing telemedicine. For example, if the ND is in Ontario and the patient is in British Columbia, which is a regulated province for NDs, the ND who is not registered to practice in BC could be considered to be practicing in that jurisdiction without legal authorization. In a province or country where NDs are unregulated the legislation of that jurisdiction may make it unlawful for them to provide naturopathic care for the patient.

It is the responsibility of the ND to ensure they are aware of the laws of the jurisdiction where the patient is located and to abide by them as well as the regulations and standards of the College.

Will my Professional Liability Insurance provide coverage if patients are located outside of Ontario?

Check with your insurance provider to ensure whether or not you have proper coverage for conducting visits with patients located outside of Ontario. Consider the possibility that someone living outside of the province may choose to initiate legal proceedings for alleged malpractice in their province of country, particularly if the foreign jurisdiction allows for the potential of higher damages to be awarded as compared to what may be allowed in Ontario.

While patients are often looking for more convenient ways to access their health care providers through the use of telemedicine, it is the responsibility of the ND to ensure that every patient receives the same level of care and consideration of privacy as they would during an in office visit.

Additional resources:

Personal Health Information Protection Act, 2004

Information and Privacy Commissioner