Questions and Answers about the Provincial Health Officer’s March 23, 2020 Update for Regulated Health Professionals

The College of Optometrists of BC (the “College”), along with other colleges, have compiled questions and answers about Provincial Health Officer (PHO) Dr. Bonnie Henry’s March 23, 2020 update for regulated health professionals.

What does this update from the Provincial Health Officer mean for registrants of The College of Optometrists of BC (College)?
· The PHO’s update is consistent with previous advice/recommendations issued by the College.

In her update, Dr. Henry said: “All non-essential and elective services involving direct physical contact with patients and clients should be reduced to minimal levels, subject to allowable exceptions, until further notice.” What is considered to be non-essential or elective care during the COVID-19 pandemic?
· The College recognizes that our registrants have the training and expertise to make decisions and provide care based on the unique needs of each patient. However, in light of the extraordinary situation brought about by the COVID-19 pandemic, the College is providing more detailed guidance.
· In general, emergent care refers to immediate management or treatment of potentially life-threatening conditions.
· In general, essential care focuses on the management and treatment of conditions that require prompt attention, and is separate from emergency care.
· The College strongly recommends that registrants cease delivery of non-essential and elective care during the special situation of the COVID-19 pandemic. This is care that is neither emergent nor urgent.

Dr. Henry said in making decisions regarding the reduction or elimination of non-essential and elective services, health professionals should be guided by their regulatory college and a series of principles, including “reciprocity”. What does reciprocity mean?
· Dr. Henry explained reciprocity by saying, “Certain persons or populations will be particularly burdened as a result of a reduction in non-essential services. As such, patients should have the ability to have their ocular health monitored and it be reevaluated as required”.
· To give effect to this principle, the College recommends that registrants develop a plan for patients who have contacted your office requesting care that you have determined to be non-essential due to the COVID-19 situation. You should have a plan to ensure that you can take action should their needs change and they require essential or emergent care.
· Such a plan may include providing patients with specific instructions to contact you should their condition change; providing ongoing follow up from your office to assess their condition; or immediately directing them to an alternate source of care, such as another health care professional or hospital.

How should I screen my patients for COVID-19?
· You should first ask the patient if they are experiencing any symptoms of COVID-19, as described by the BC Centre for Disease Control (BCCDC), including cough, sneezing, fever, sore throat, and difficulty breathing.
· You should ask about any recent travel outside of Canada.
· You should ask about any contact with individuals who have a confirmed or presumptive diagnosis of COVID-19.
· Always attempt to pre-screen patients by telephone, if possible.
· As suggested by BCCDC, individuals can use the COVID-19 BC Support App and Self-Assessment Tool to help determine if they need further assessment or testing for COVID-19

What are the implications of providing hands-on care?
· When direct physical contact is required for the care of patients with presumptive or confirmed COVID-19, health professionals must use infection control practices. See the BCCDC’s page on COVID-19 Infection Control.
· If you are not able to ensure adequate infection control, do not provide care to the patient. Seek an alternate approach to meet their care needs (e.g. referral to another provider or facility).

Where can I find more information on providing virtual care?
· We refer you to the College’s policy on teleoptometry.
· We refer you to the March 24, 2020 College email – MSP Billing for Teleoptometry
· The Office of Virtual Health and Digital Health Team at Provincial Health Services Authority (PHSA) has developed a Virtual Health toolkit for use during the COVID-19 pandemic. The toolkit provides information on virtual care technology solutions, endorsed by the Ministry of Health and PHSA. COVID-19 resources on the BCCDC website also link to the toolkit.
· The Virtual Health toolkit includes email as a solution, and notes that Canadian privacy laws apply to email accounts based in Canada. BC’s Personal Information Protection Act (PIPA) outlines rules applicable to private practice registrants about the collection, use, and disclosure of information. Ensure your virtual care solution is PIPA compliant.