Are you up to standard? The three most-asked-about standards of practice

Read time: 4 minutes

As physicians and physician assistants in Alberta, you are responsible for understanding and adhering to CPSA’s Standards of Practice. Some standards are more complex than others, and you may have questions about how they apply to your unique practice or circumstance. We’re here to help!

Since its launch in October 2022, CPSA’s Customer Experience (CX) team has been assisting with standards of practice inquiries from regulated members and patients. Over the past six months, the CX team has answered almost 600 questions about CPSA’s Standards of Practice and has noticed that three standards seem to pop up more often than the rest: Patient Record Retention, Referral Consultation and Terminating the Physician-Patient Relationship.

Read about these frequently asked questions to refresh your memory:

Patient Record Retention

1. Does the paper version of the record need to be kept if an EMR is adopted?

It depends. If the paper version is scanned and uploaded into the EMR, the paper record can be destroyed. However, if the paper record is not otherwise combined with the EMR (e.g., a large 30-year record), the paper version must be retained for 10 years past the last date of entry along with any entries in the EMR.

2. When transitioning to an EMR, can any of the paper versions of a patient’s record be removed?

In large records, such as the 30-year record example mentioned above, it is reasonable to exclude information unlikely to be pertinent to the patient’s health history as long as a high-level summary of the exclusion(s) is documented (e.g., a simple ear infection from 10 years ago that resolved with a course of antibiotics). As long as there is a note in the record that lab/investigation results are available in Netcare, it is also reasonable to exclude these documents when uploading a paper record to an EMR.

3. Do I have to retain only the last 10 years’ worth of entries in a patient’s record, or am I expected to keep the whole record for 10 years past the last date of entry?

The patient’s record consists of all entries in their entirety, meaning the entire record must be maintained for 10 years past the last date of entry, even if you’ve been seeing a patient for 30+ years. For example, the record of a patient who is seen from Jan. 1, 2021, to Dec. 3, 2023, but then leaves the province, must be kept until Dec. 3, 2033. The entire 36-year record of a patient who is seen from Apr. 5, 1987, until they pass away on Aug. 18, 2023, must be kept until Aug. 18, 2033.

Referral Consultation

1. Who is responsible for communicating referral outcomes?

In non-hospital/emergency situations, generally speaking, the specialist relays pertinent information directly to the patient as part of the treating relationship, with a written follow-up report to the referring healthcare provider (see clause 10(b)).

Hospital/emergency settings are considered episodic care, so that standard of practice must also be considered; clauses 1 and 2 require regulated members providing episodic care to either personally provide necessary follow up or arrange follow-up care (in accordance with the Transfer of Care standard). If a patient does not have a primary care provider who can provide follow up, the specialist may need to get in touch with the patient directly.

2. Does a referral get abandoned if it’s on a waitlist for too long? Who is responsible for following up on and communicating the status of the referral?

Referrals should not expire or be abandoned regardless of the length of the waitlist. If a waitlist is becoming quite long, the referring healthcare provider should be advised so they may discuss, with their patient, the possibility of referring to another provider. Additionally, specialists may wish to consider temporarily closing their practice to new referrals until the waitlist is manageable.

Clause 10(a)(i) addresses the responsibility of specialists to regularly update patients on their referral status (at least every three months).

3. Can referrals be made to or from out of province physicians?

Generally speaking, yes. If a patient is willing/able to travel and cannot otherwise obtain the same care locally in a reasonable amount of time, an out-of-province referral can be made.

Terminating the Physician-Patient Relationship

1. What is considered abusive behaviour by the patient? Is there a threshold to terminate? How might this differ from respecting professional boundaries?

Abusive behaviour generally includes, but is not limited to, harassment, bullying, obscene language or gestures, verbal abuse, threats of physician abuse, and/or actual physical abuse.[1] Regulated members are not obligated to continue providing care to patients who exhibit this type of behaviour and may immediately discharge the patient in accordance with clause 5. Any/all instances of perceived abuse should be documented in a factual manner in the patient’s record.

In the context of clause 5, respecting professional boundaries would align with the Boundary Violations: Personal and Boundary Violations: Sexual standards (e.g., a patient who professes a romantic interest, demands special treatment, or has a conflict of interest, etc.).

2. How long from the last patient visit is the patient no longer considered a patient?

There is no time frame after which a patient is automatically considered discharged from a practice, and considerations must be made when unilaterally discharging a patient from the practice for not seeking medical care for a number of years.

Regulated members may consider a time frame after which they reach out to patients to determine whether the patient still considers them to be their primary care provider and proceed accordingly (e.g., leave them in the patient panel or terminate in accordance with clause 4). It should be understood that the patient cannot be unilaterally terminated from a regulated member’s panel simply because they have not attended for care within that period of time.

3. Once terminated, what obligation is there to connect the patient directly with another physician?

Regulated members are not obligated to connect a patient to a new healthcare provider.

Questions? CPSA has created Advice to the Profession documents for many of the standards linked above, and our team members are happy to assist if you have any further questions. Please reach out to support@cpsa.ab.ca for more information.

[1] From Law Insider’s “Abusive behavior” definition.