A PDF version of this Standard can be downloaded here.
Introduction
Most physiotherapists already use some form of information and communications technology when providing care, and this has become an integral part of physiotherapy practice. Telehealth can help patients in isolated locations receive necessary care, provide patients with more convenient access to care, allow for more comprehensive delivery of services after-hours and allow for the more efficient use of health resources. Telehealth is particularly useful when it is incorporated into an existing system for providing patient care.
In using telehealth, physiotherapists should be aware of its limits and ensure that they do not attempt to provide a service, which puts patient safety at risk. In particular, be aware of the inherent risks in providing treatment when a physical examination of the patient is not possible. For the purpose of this standard ‘treating’ and ‘treatment’ covers all aspects of the practice of physiotherapy including assessing, diagnosing, reporting, giving advice, signing certificates, and prescribing exercise programmes.
If physiotherapists provide care to New Zealand-based patients from overseas via telehealth, the Physiotherapy Board of New Zealand (Board) holds the view that they are practising physiotherapy within New Zealand and should, therefore, be registered with the Board.[1] When utilising telehealth, physiotherapists are subject to the same requirements as physiotherapists registered and practising in New Zealand. These include the Board’s competence, conduct and health procedures and the complaints resolution processes of the office of the Health and Disability Commissioner. The Board will also notify the appropriate regulatory authorities in other countries if concerns are raised about a particular physiotherapists’ practice.
The New Zealand Code of Health and Disability Services Consumers’ Rights establishes the rights of patients and places corresponding obligations on physiotherapists with respect to telehealth, as they do with all other forms of health care. This includes but is not limited to informing patients about the provision of telehealth services and seeking the patient’s informed consent before the telehealth service is provided.
Definitions
The Board has defined the following terms as:
In-person: Where the physiotherapist and patient are physically present in the same consultation room.
Telehealth: The use of information and video conferencing technologies, to deliver health services to a patient and transmit health information regarding that patient between two or more locations at least one of which is within New Zealand.
Video consultation: Where the physiotherapist and patient use information and video conferencing technologies to communicate with each other and visual and audio information are exchanged in real time, but the physiotherapist and patient are not physically present in the same consultation room. A video consultation can be conducted between a physiotherapist and patient in the presence of another health practitioner, or it can be conducted with no health practitioner support at the patient’s end.
1. Telehealth scope of practice
This standard applies to physiotherapists registered in New Zealand and practising telehealth in New Zealand and/or overseas, and physiotherapists who are overseas and provide health services through telehealth to patients in New Zealand. In both these instances, the physiotherapists must be registered and hold a current Annual Practising Certificate (APC).
2. Providing care
2.1. Any device, software or service used for telehealth must be secure, only allowing the intended recipients to receive and record, and be fit for It must preserve the quality of the information or image being transmitted.
The Board expects the treatment provided to a patient in another location meets the same required standards as care provided in an in-person consultation.
This includes standards relating to:
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- patient selection, identification, cultural competence, assessment, diagnosis, informed consent, maintaining the patient’s privacy and confidentiality,[4] updating the patient’s clinical records and communicating with the patient’s relevant primary care provider in a timely manner (unless the patient expressly states that the details of the telehealth consultation are not to be shared with their primary care provider), and follow-up.
- If, because of the limits of technology, the same standard of service cannot be provided as an in-person consultation then the patient must be advised of this limitation.
2.2. It is particularly important that consideration is given to whether a physical examination would add critical information before providing treatment to a patient or before referring the patient to another health practitioner for services such as diagnostic imaging. If a physical examination is likely to add critical information, then it should not proceed until a physical examination can be arranged. In some circumstances, it may be reasonable to ask another health practitioner in the patient’s locality to conduct the physical examination. In those instances, it is important that the patient’s informed consent be obtained and communicated clearly for that arrangement, and the referring physiotherapist is available to answer any queries.
2.3. When working with or receiving reports from telehealth providers, physiotherapists should ensure that the above standards are followed and must notify that telehealth provider, their management and other appropriate reporting channels if there are concerns about the quality of care being provided.
3. Providing care to a patient located outside New Zealand
3.1. Physiotherapists providing care from New Zealand to patients in another country:
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- remain subject to New Zealand law
- may be subject to other legal obligations, requirements or liabilities in the location where the patient is located
- may also be subject to the jurisdiction of authorities in the patient’s home country
- may be liable if the patients are assisted to contravene that country’s laws or regulations, for example, any importation and possession requirements.
- legal advice should be sort in that country, if necessary.
4. Insurers and third-party payers
Physiotherapists must understand and abide by the policies or recommendations of insurers or third-party payers regarding telehealth. If the insurers or third-party payer policy is unclear, they should be contacted before any assessment and treatment are undertaken.
Related resources
Aotearoa New Zealand Code of Ethics and Professional Conduct (2018) Principle 8
The Code of Health and Disability Services Consumers’ Rights
Royal Australasian College of Physicians’ Telehealth Guidelines and practical tips
Internet and electronic communication Standard
NZ Telehealth Resource Centre (2018)