Part 3 Provision of Care and Privacy

3.5 A chiropractor may provide virtual care services in accordance with Appendix “P” of the Handbook.

APPENDIX “P”: Standard of practice: Virtual Care

Virtual care can be an effective tool to deliver non-pharmacological interventions to patients. Chiropractors in BC may provide virtual care to patients, including consultation and the provision of chiropractic care information and direction to patients through the use of telephone
and other electronic communication media.

Virtual care services may include:

a. monitoring and prescribing changes to therapeutic exercise programs,

b. recommending modifications for supports and devices already in the
possession of the patient,

c. recommending supports and devices that are available “over the counter” and that are adjunctive to, and directly related to, the Scope of Practice (PCH 9.1), and

d. advice and counseling on matters related to the condition of the spine or other joints of the body and the associated tissue, the nervous system and the overall health of the individual.

Virtual care encompasses all forms of remote consultation and provision of care information and direction regardless of the communication technology used or whether different terminology is used by a chiropractor to describe the patient interaction.

The College reminds chiropractors that the use of technology does not alter the ethical,
professional and legal requirements that apply to the provision of chiropractic care.

• Chiropractors who choose to participate in virtual care must continue to meet all the same legal, ethical and professional obligations that apply to in-person practice.

Only a chiropractor may provide virtual care services. A chiropractor must not delegate any aspect of virtual care.

Subject to the standards for virtual care described below, chiropractors must use their professional judgment when determining whether virtual care is appropriate for a patient and consider any barriers for the patient in accessing virtual care (example: patient does not have a suitable device or is not able to use technology to successfully complete a virtual care appointment).

Before providing virtual care, chiropractors must confirm with their professional liability protection or insurance provider that they have appropriate coverage in accordance with s. 84 of the CCBC Bylaws.

Standards for virtual care

The following standards apply to chiropractors providing virtual care in BC:

1. A chiropractor providing virtual care must be physically located in BC and may only provide virtual care to a patient who is in BC at the time when services are provided. Virtual care services are not permitted for persons who are outside of BC at this time.
2.  A chiropractor may only provide virtual care if:
   (a) providing virtual care is in the patient’s best interest, considering the patient’s current condition and care needs,and
   (b) virtual care allows for adequate assessment of the patient’s presenting problem and care needs.
3. When providing virtual care to a patient, a chiropractor must:
4. (a) confirm
      (i) the patient’s identity, and
      (ii) his or her identify for the patient,
   (b) explain the appropriateness, limitations, and privacy risks related to virtual care to the patient,
   (c) obtain informed consent from the patient in accordance with the requirements for in-person care, and create a written record of having done so,
   (d) maintain clinical records for all provided services in accordance with the
   requirements for in-person care,
   (e) ensure that the communication technology used and the physical location of both the chiropractor and the patient does not compromise the privacy and confidentiality of the patient’s personal health information, and
   (f) provide follow-up consultation and care as appropriate.
5. If providing virtual care to a new patient, a chiropractor must
   (a) obtain an adequate initial history,
   (b) use video communications to conduct any assessment and examination
   procedures requiring observation, noting the form of video communication
   used in the patient’s clinical record, and
   (c) as soon as possible following the initial consultation, provide the patient with a written report of findings, including a plan of management and noting any limitation in reaching a diagnosis due to constraints on assessment using virtual care.
6. Before providing virtual care, a chiropractor must inform the patient of any
   applicable fees.
7. All receipts for virtual care services must clearly state that the services were delivered using virtual care.
8.  If seeking reimbursement of fees for virtual care services from a third-party payor, a chiropractor must advise the third-party payor that the services were provided using virtual care