Protecting the public interest while regulating health professionals providing virtual care: A scoping review

Technology is transforming service delivery in many health professions, particularly with the rapid shift to virtual care during the COVID-19 pandemic. Health profession regulators must navigate legal and ethical complexities to facilitate virtual care while upholding their mandate to protect the public interest. The objectives of this scoping review were to examine how the public interest is protected when regulating health professionals who provide virtual care, discuss policy and practice implications of virtual care, and make recommendations for future research. We searched six multidisciplinary databases for academic literature published in English between January 2015 and May 2021. We also searched specific databases and websites for relevant grey literature. Sources were screened in duplicate against specified inclusion criteria. Fifty-nine academic articles and 18 grey literature sources were included. Data from included sources were extracted and descriptively synthesized. We identified five key findings. Most literature did not explicitly focus on the public interest aspects of regulating health professionals who provide virtual care. However, when the public interest was discussed, the dimension of access was emphasized. Criticism in the literature focused on social ideologies driving regulation that may inhibit more widespread use of virtual care, and subnational occupational licensure was viewed as a barrier. The demand for virtual care during COVID-19 catalyzed licensure and scope of practice changes. Virtual care introduces new areas of risk, potential harm, and inequity that health profession regulators need to address as technology continues to evolve. Regulators have an essential role in providing clear standards and guidelines around virtual care, including what is required for competent practice. There are indications that the public interest concept is evolving in relation to virtual care as regulators continue to balance public safety, equitable access to services, and economic competitiveness. Non-Technical SummaryTechnology is transforming how many health professionals provide services, particularly with the rapid shift to virtual care during the COVID-19 pandemic. Many of these health professionals are accountable to a regulator that sets standards of practice, including for virtual care. These regulators have a mandate to protect the public. We conducted a review to determine whether there was existing evidence or literature about how these regulators were working to protect patients when health professionals were providing virtual care. Most of the literature we found did not explicitly focus on the public interest when discussing how to regulate health professionals who provide virtual care. However, when the public interest was discussed, access to care was emphasized. Criticism in the literature focused on social ideologies driving regulation that may inhibit more widespread use of virtual care, especially as the demand for virtual care during COVID-19 catalyzed regulatory changes. Virtual care introduces new areas of risk, potential harm, and inequity that regulators need to address as technology continues to evolve. Regulators have an essential role in providing clear standards and guidelines around virtual care, including what is required for health professionals to be competent.