Clinical governance
Accountable medicine.
Before, during and after each visit.
This framework describes how physician oversight, safety checks and quality review would work. It must be approved by the responsible physician before any service opens.
Medical leadership
The Medical Director is [Responsible physician / Medical Director name], a physician licensed in [jurisdiction]. The Medical Director is accountable for clinical protocols, physician onboarding, quality review and clinical incident management, and has authority to pause any service on safety grounds. Clinical decisions are not made by non-physician staff or by software.
Licensure verification
- Each physician’s licence is verified at onboarding against the public register of each regulator where they will practise.
- Licences are re-verified periodically, at least [annually], and whenever a register shows a change in status, conditions or restrictions.
- Patients are matched only with physicians authorized in the province or territory where the patient is located at the time of the visit. If the location cannot be confirmed, the visit does not proceed.
- Any condition or restriction on a licence is respected in scheduling and scope of practice.
Professional liability protection
Each physician must hold appropriate professional liability protection, such as membership in the Canadian Medical Protective Association (CMPA) or equivalent coverage, that applies to virtual care in the relevant jurisdictions. Coverage is verified at onboarding and on renewal.
Clinical protocols and triage
Approved protocols define which conditions are suitable for virtual assessment, what information is needed and when in-person care is required. Intake screens for red flags, and any red flag prompts immediate advice to seek emergency care. Examples include:
- Chest pain or pressure, or difficulty breathing.
- Signs of stroke, such as facial drooping, arm weakness or trouble speaking.
- Severe allergic reaction, uncontrolled bleeding or a sudden, severe headache.
- Thoughts of suicide or of harming others.
- Signs of serious infection, confusion or loss of consciousness.
- Heavy bleeding or severe pain in pregnancy.
Escalation to emergency and in-person care
If a patient needs emergency care during a visit, the physician directs them to call 911 or, where appropriate, contacts emergency services with the patient’s location. When in-person care is needed, the physician advises the patient on appropriate local options. [Formal in-person care arrangements are required by some regulators, such as New Brunswick, and must be in place before that jurisdiction opens.]
Quality review and chart audit
- A sample of visit records is reviewed regularly [sampling rate to be set] against protocols and documentation standards.
- New physicians have an increased review rate during their first [period].
- Prescribing, document issuance and referral patterns are monitored for unusual variation.
- Findings are shared with physicians for learning and tracked to resolution.
Incident reporting
Staff and physicians must report clinical incidents, near misses and privacy incidents promptly. Incidents are reviewed without blame to find causes and prevent recurrence. Patients affected by a harmful incident are told about it, consistent with disclosure obligations. Reports to regulators, privacy commissioners or other authorities are made as the law requires.
Continuity of care
With your consent, a visit summary is sent to your regular family physician or nurse practitioner. Results of any tests ordered are followed up by the ordering physician or a clearly designated colleague. Patients without a regular provider are given advice on local options and on what follow-up they need.
Physician independence
- Physicians are not paid incentives tied to issuing notes, prescriptions, forms or referrals.
- Physicians are not given targets for the number or type of documents or prescriptions issued.
- No one at the operating entity may pressure a physician to reach a particular clinical decision.
- Commercial arrangements are reviewed by counsel for compliance with rules on fee splitting, conflicts of interest and advertising.
Records
Clinical records are kept to the documentation standard of the applicable regulator, retained for the required period and protected as described in the clinical privacy notice.