Policies

Policy Briefs

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Privacy and eConsult

eConsult aheres to existing privacy legislation

Position Statement
The purpose of this page to clarify the definition of privacy as it pertains to eConsult services and highlight key steps for providers and service implementers to ensure patient information remains
secure.

Ensuring patient privacy – key steps for providers
Patients have a right to ensure that their personal health information remains private and confidential. As such, providers must be able to confirm that any eConsult service they use in providing patient care has sufficient protocols in place to protect patients’ privacy. Providers who wish to confirm an eConsult service’s security may take the following steps:

Ask the service provider to verify the presence of appropriate safeguards. Providers may wish to confirm that these safeguards are matched by their own administrations.
Review the privacy legislation enacted in their jurisdiction (see Table).
Consult a provincial/territorial privacy commissioner if there are any concerns.

Elements of a secure eConsult service – key steps for service implementers
In order for an eConsult service to function, patients must be able to rely on it to protect their personal health information. In developing an eConsult service, innovators must ensure that:

All data is transmitted through a secure network and stored on a secure Canadian server.
The service meets the minimum standards for privacy.
Everyone who uses or has access to patient data has sufficient training and certification to ensure the information is handled in a safe and professional manner. Only providers or their delegates should be able to access the account.
The innovation adheres to all pieces of privacy legislation in effect in its jurisdiction. A privacy impact assessment can ensure that all aspects of such legislation are met.
The role of the health information custodian is clearly defined.

Table: Personal Health Information Protection Acts for all provinces/territories

Region	Act	Latest Version	View
BC	Personal Information Protection Act	2016	View Here
AB	Personal Information Protection Act	2014	View Here
SK	The Freedom of Information and Protection of Privacy Act	2019	View Here
MB	Personal Information Protection Act	2014	View Here
ON	Personal Health Information Protection Act	2022	View Here
QC	An Act Respecting the Protection of Personal Information in the Private Sector	2021	View Here
NB	Personal Health Information Privacy and Access Act	2022	View Here
NS	Personal Health Information Act	2022	View Here
PEI	Freedom of Information and Protection of Privacy Act	2022	View Here
NL	Personal Health Information Act	2019	View Here
YK	Access to Information and Protection of Privacy Act	2019	View Here
NT	Access to Information and Protection of Privacy Act	2022	View Here
NU	Access to Information and Protection of Privacy Act	2021	View Here

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Interjurisdictional licensing and eConsult

Position Statement

Clear interjurisdictional licensing agreements are needed to clarify rules regarding providers’ ability to offer care advice for patients outside of their province/territory. Such agreements would maximize eConsult’s ability to improve access to care for patients in remote or rural regions.

The importance of interjurisdictional licensing

As an online platform, eConsult connects PCPs and specialists regardless of their geographic distance. However, ambiguity over licensing mean that providers in one province/territory face barriers in accessing advice from providers in a different jurisdiction. This limits eConsult's ability to improve access for patients in less populous regions, who may need to travel thousands of kilometers for specialist care.

Recommendations
To support interjurisdictional eConsults and ensure patients across Canada receive equitable access to prompt specialist advice, several key objectives should be met:

Identify and build on existing interjurisdictional agreements enabling providers to treat patients outside of their jurisdiction, which can provide a useful template for broader implementation of eConsult services (see Figure).
To avoid redundancies in licensing across multiple provinces, consider creating a distinct “virtual license” that would operate as a separate jurisdiction. Providers across Canada could seek licensing from this body in addition to their home province. A college from a more populous province could oversee this virtual jurisdiction.
Establish clear accountability guidelines for advice given through eConsult. Specialists should ultimately be accountable for the advice they give, regardless of how that advice is delivered. Existing policies for hallway/telephone consults can provide a helpful guide.
Work with colleges to streamline the process. Create a working group of officials from multiple colleges and organizations (e.g. Canadian Medical Protective Association).

Policy Brief - Interjurisdictional licensing1024_2.png

Figure: Existing interjurisdictional licensing agreements between provinces/territories

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Quality Assurance and eConsult

Position Statement

As eConsult services expand to new jurisdictions, clear quality assurance guidelines are needed to ensure that all patients receive equitable access to high-quality specialist advice.

Measuring Quality
An eConsult service can use several methods to gauge quality. For instance, the Champlain eConsult BASE™ service collects usage data automatically, and PCPs complete a mandatory survey at the closing of each case describing its outcome (i.e. whether a referral was required), quality, and educational value. Regular feedback is also sought from users through surveys, interviews, and focus groups.

Recommendations/Key Considerations
The ongoing success of an eConsult service depends on its ability to consistently provide PCPs with prompt access to high-quality specialist advice. To ensure ongoing quality, we recommend implementing the following strategies:

Follow established standards set by regulatory authorities (e.g. provincial colleges).
Evaluate the content and quality of questions asked, and define how they will be assessed.
Create a process for random auditing of eConsults. This could be accomplished by leveraging existing processes (e.g. random chart audits conducted by provincial regulatory colleges).
Inform patients about the service and ensure they are aware it meets high quality standards.
Engage PCPs through surveys and interviews to assess if eConsult facilitates their ability to treat patients according to current and applicable standards of care.
Ensure that specialists are able to receive feedback from PCPs on their responses.
Use an established framework to assess key quality metrics. For instance, The Champlain eConsult BASE™ team uses the Quadruple Aim framework as a lens to assess eConsult’s impact on:

Population Health

mortality, morbidity, rate of provider adoption

Provider Experience

satisfaction, description of service benefits

Patient Experience

response time, referral avoidance, satisfaction

Cost Savings

cost/case, external costs (e.g. tests), patient savings

1. Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. The Annals of Family Medicine. 2014 Nov 1;12(6):573-6.

Payment and eConsult

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Position Statement

As eConsult services expand across Canada, new payment models are needed to ensure providers are appropriately remunerated.

Remuneration for Providing eConsult Services
Payment for eConsult services varies between services, clinics, and jurisdictions. Different models have been attempted, including fee-for-service, session fees, and salaried models. On the payer side, the rate for eConsult varies between jurisdictions, with some provinces/ territories having adopted fee codes for eConsult (see Table).

Some eConsult services remunerate providers using their own system (e.g. Champlain BASE pays most specialists $220/hour prorated to time spent completing a case, with some variation based on individual payment models). As eConsult services become more common, a more concrete, streamlined approach will be necessary to support clear and reasonable remuneration strategies.

Recommendations/Key Considerations
Policymakers and innovators must work together to develop new policies that clearly outline how health care providers are paid for eConsults. Key steps include:

Developing a consistent set of fee codes for eConsult, which providers can use to bill the provincial/federal government as they do for other services. For guidance, look to provinces that have already established fee codes for eConsult services (e.g. Alberta).
Encouraging consistency between jurisdictions. Creation of a national set of fee codes may raise significant policy challenges, but coordination between provinces/territories would facilitate eConsult’s use across borders.
Accounting for interjurisdictional eConsults by adopting a “payment follows patient” policy, with the patient’s home jurisdiction ultimately responsible for covering the cost of their care.
Engaging ministries of health, medical associations, and regulatory colleges from participating provinces/territories to create a consistent approach to provider remuneration.

Fee codes in each province/territory for eConsult and teleconsult services (2017)

Original source: Stanistreet K, Verma J, Kirvan K, Drimer N, Liddy C. Physician Remuneration for Remote Consults: An Overview of Approaches across Canada. Healthcare quarterly (Toronto, Ont). 2017;20(3):12.

Regulation and eConsult

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Position Statement

When implementing eConsult in new jurisdictions, regulations are needed that ensure all patients receive high-quality care without impeding the service's ability to deliver that care.

Current Regulatory Status
In Canada, eConsult services currently operate under a different set of requirements than a national, full-scale health intervention. While some regulatory elements apply (e.g. those protecting patient privacy), others, such as those governing payment or defining the specialist role, are treated differently.

Recommendations/Key Considerations
In order to facilitate eConsult’s transition to a full-scale, multi-provincial or national service, regulations must be established on a number of key issues, including payment, licensing, and liability.

Examine existing fee codes to determine best strategies for provider payment. The concept of “payment follows patient” should be upheld.
Ultimately, specialists should be accountable for the advice they give.
Define a set of key characteristics that participating providers should demonstrate (e.g. experienced, courteous, and capable of delivering timely responses).
Develop best practices for PCPs and specialists who join the service in order to ensure patient safety.
Determine how specialist competencies should be evaluated: what makes a good response? The Champlain BASE team is currently examining how eConsult cases can be incorporated into continuing medical education. These studies will help inform what makes a quality eConsult.
Establish clear consequences for providers who fail to meet the minimum standard of care. Providers should be made aware of these consequences from the outset.
Leverage the feedback loop built into eConsult’s structure, which allows for gathering of user responses in real-time through usage data and survey responses.
Promote eConsult to patients and the general public to encourage their providers to use the service.