What is Telepractice
Telepractice (also called virtual practice) can be defined as the use of technology to deliver healthcare services without direct contact between the practitioner and the patient. While technology continues to change, some examples of technology used in telepractice include telephone, email and video conferencing such as Skype.
TCM and Telepractice
In the context of TCM, telepractice has its limitations. The Traditional Chinese Medicine Act, 2006, defines the scope of traditional Chinese medicine as the assessment of body system disorders through traditional Chinese medicine techniques and treatment using traditional Chinese medicine therapies to promote, maintain or restore health.
Furthermore, under the College's Standard for Diagnosis and Treatment, TCM practitioners must effectively perform a physical assessment of the patient for the purpose of health promotion, diagnosis and/or management that is relevant and accurate.
Many TCM assessments (such as smelling, palpation, and pulse-taking), require in-person contact and cannot be done remotely. As such, telepractice is not a comparable alternative for an in-person TCM visit.
In some cases, it may be appropriate to use telepractice to monitor an existing patient or to provide an opportunity for the patient to communicate with the practitioner. However, it would not be appropriate to use telepractice to perform a physical assessment of the patient for the purpose of performing a TCM diagnosis and subsequent treatment. Telepractice is not appropriate for treatments such as acupuncture, cupping, gua sha, and Tuina.
Members engaged in telepractice are accountable for the care they provide to their patients. They must use their professional judgement to assess if the use of telepractice is in the patient's best interest. They must consider each patient's condition and their individual needs. To manage patients' expectations, members should clearly explain their scope of practice and the limitations of telepractice.
As in any practice situation, Members who engage in telepractice must comply with all regulations and standards of practice of the College. Their patients must receive safe, competent and ethical care, regardless of how that care is delivered. When providing care, members must choose the tools that are the most appropriate for their patients.
Privacy and Confidentiality
Members are expected to keep all personal health information confidential as required by the College’s standards of practice and legislation. When engaging in telepractice, members must take measures to implement security mechanisms that protect their patients' personal health information. For example, members must ensure that their use of mobile phones and apps does not allow for accidental access or dissemination of the patient's information to unauthorized third parties. Members should also ensure they assess if the patient's setting and their own setting is one that provides a safe, secure, and confidential environment to discuss patient-related matters.
For more information pertaining to safeguarding personal health information, please see the office of the Information and Privacy Commissioner of Ontario.
The requirement for members to obtain patients' consent is the same for telepractice and in-person patient care. Members should inform their patients about the risks associated with providing services in ways other than in-person interactions. For more information, please see the Standard for Consent.
Members engaged in telepractice are required to maintain patient records in accordance with the College's Standard for Record Keeping. Members must maintain comprehensive clinical records and document all patient encounters that take place through telepractice.
Fees and Billing
Members are expected to advise their patients (upfront) of all fees associated with telepractice. Where possible, members should also ensure these fees are posted so that patients have all relevant information to make informed decisions. For more information, please see the Standard for Advertising.
College of Naturopaths of Ontario (2020). Regulatory Guidance Telepractice - Providing Naturopathic Care at a Distance.
College of Occupational Therapists of Ontario (2017). Guidelines for Telepractice in Occupational Therapy.
College of Physiotherapists of Ontario (2020). Tele-practice: Guidelines and Resources for Physiotherapists.
The College of Traditional Chinese Medicine Practitioners and Acupuncturists of British Columbia (2020). College’s Statement Regarding Tele-Practice During the COVID-19 Pandemic March 18, 2020.
College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario. Standard for Diagnosis and Treatment (2013).