Vice President of Media Strategy, NAVC
Over the past few weeks, several states have amended their laws to allow the use of telehealth in an effort to provide patients and doctors with a way to interact without physical contact. The FDA temporarily suspended enforcement of some federal veterinarian-client-patient relationship (VCPR) requirements.
But once the COVID-19 crisis has passed, will veterinarians continue to offer telemedicine? Will they consider that many of today’s pet owners also want digital messaging and video chatting capabilities when it comes to medical care for their pets? Will they take advantage of lessons learned during the COVID-19 crisis and implement a process that makes sense for their practices?
Telemedicine doesn’t take much in the way of equipment — often, all you need are two computers or phones with built-in cameras and microphones (one in the clinic and one in the client’s home). If you already text clients to follow up after an appointment, provide advice on the phone about a medication, provide the results of a lab test, or answer a question about a patient’s behavior, you’re using telemedicine. In fact, if you sometimes monitor a patient remotely, even if it is in the clinic and you are checking vital signs from a computer located in a room separate from where the patient is, you’re using telemedicine.
Definitions and Terms
There are a number of terms that are used when people are discussing telemedicine. These definitions, published in Today’s Veterinary Practice, in the article Veterinary Telehealth: What Is It, Where Are We, and What’s Next?, written by Mia Cary and Aaron Massecar, may be useful:
Telehealth: This term that encompasses all uses of technology geared to remotely deliver health information, education, or care.
Telemedicine: A subcategory of telehealth that is a tool, or use of a tool, to augment the practice of veterinary medicine (e.g., using Skype or an app to communicate with a client and visualize the patient for a postoperative follow-up examination and discussion).
Teleconsulting: A subcategory of telehealth that occurs when a general practice veterinarian uses telehealth tools to communicate with a veterinary specialist to gain insights and advice on the care of a patient.
Cary and Massecar also list the scenarios that veterinarians are using for telehealth, though they may not be thinking of them as telehealth:
• Postoperative follow-up
• Dermatologic concerns
• Behavioral issues/training
• Transportation issues
• Hospice care
• Basic triage (whether the pet should be seen by the veterinarian)
• Environmental concerns/hazards that might contribute to a particular condition
• Long-term care monitoring
Barriers to Veterinary Telemedicine
The main barrier is the veterinary–client–patient relationship (VCPR). State veterinary medical associations must be willing to adopt a more modern, flexible view of the VCPR in order for telemedicine to become acceptable. As Mark Cushing notes in his article, A Regulatory Road Map for Telehealth and Pet Health Care, also published in Today’s Veterinary Practice, human health state governing bodies turned the doctor-patient relationship “into a doorway for health care, not an impenetrable wall.” He asks: “Why can’t veterinary medicine do the same thing?”
Cushing answers the most common questions related to this issue on the human health side:
Doctor–client relationship: Can this be formed via telemedicine? “Yes, in all 50 states.”
Multi-state licensure: Can state boards still require the treating doctor to be licensed where the patient resides? “Yes, although some states are more flexible.”
Online prescriptions: Is a doctor–client relationship still a requirement? “Yes.”
Informed consent: Can state boards require that a client consent to being served through telemedicine? “Yes, although some states do not require this.”
Privacy/security: Can state boards require that telemedicine adhere to the same requirements as in-person examinations and treatment? “Yes.”
Standards of care: Are they the same for telemedicine as for in-person examinations and treatment? “Yes.”
There are, of course, other challenges: Staffing, pricing, technology, and standard of care requirements must all be addressed by individual practice owners. But as the current COVID-19 crisis has shown, technology can be used effectively to provide quality, sometimes life-saving care to veterinary patients.
The Benefits of Telemedicine
The Bayer Veterinary Care Usage Study III: Feline Findings found that more than half (52%) of America’s 74 million cats are not receiving regular veterinary care, potentially putting their health at risk. The Bayer study also determined that 40% of cats and 15% of dogs have not been to the veterinarian within a year. Telemedicine could potentially improve those percentages.
Telemedicine would also allow veterinarians to compete effectively with “Dr. Google.” Dr. Google does not have a degree or training in veterinary medicine and Dr. Google cannot comfort a client when faced with difficult decisions about their pets. Veterinarians should emphasize this in promoting their telemedicine services.
Clients who have access to their veterinarians via telemedicine can help ease the anxiety pet owners have, while helping to build their trust in their veterinarian.
Telemedicine can also free up the veterinarian’s time because in-clinic appointments will be limited to patients that need to be seen in person.
Best Practices for Implementing Telemedicine
1. For now, most states, as well as the AVMA, require a valid VCPR for a veterinarian to diagnose, prescribe medication, or otherwise treat an animal via telemedicine. Make sure you are connecting with pet owners with whom you have an established VCPR.
2. You can buy or license software so your veterinary practice can offer better telehealth services to clients. Companies like VitusVet provide this. You can also contract with an outside company to offer advice and client service when your practice is busy or closed. Companies like whiskerDocs offer this service.
3. Let your clients know. Telemedicine is a service and you need to be clear about what your telemedicine service will do. Use personal phone calls, texts, email and social media posts to inform your clients.
4. Determine on a case-by-case basis which cases are right for telemedicine. Consider duration and severity of the symptoms in deciding if a patient needs to be evaluated in the clinic.
5. Establish the services you’ll provide. Post-surgery follow-ups, check-ins, and even writing prescriptions can be done via telemedicine.
If You Use a Service or App
If you choose an animal health care professional telemedicine platform or app, make sure it has these functions or features:
Secure and Private. Make sure that your clients’ and patients’ information is securely stored.
Billing Capability. You must be able to bill clients directly through the interface.
Offers Accessibility. Decide if you want 365/24/7 accessibility or if you’d like to be offline at certain times or days. Also, it should be accessible via smartphone as well as desktop and compatible with both Android and iOS operating systems.
Interactive and Integrative. It should allow clients to text, call, and send photos or videos of their pets. It should offer real-time video calling capabilities. You should be able to integrate information and reports directly into your electronic health records system.
Allows Multiple Users. This way, various team members can answer questions.
Telemedicine is a hot-button topic in veterinary medicine and the debate will surely continue long after COVID-19 is in our rear-view mirror.
As Cary and Massecar write in Veterinary Telehealth: What Is It, Where Are We, and What’s Next? “the future presents two main opportunities for veterinary healthcare: (1) further clarifying legislation and implementation and (2) incorporating new technologies. Many open questions about telehealth remain, from informed consent and liability issues to revenue models and practice workflows. These issues are being clarified by lawyers and state boards from a legal perspective and by veterinarians, telehealth providers, and pet owners from a practical perspective. … We are moving from an era of once- or twice-a-year visits to an inexpensive and constant stream of 24/7 360° data that will provide deeper insights into our pets’ health. Veterinarians must be at the center of animal care, but this will happen only if they adapt to and incorporate these new technologies. By working together as a profession, we can create solutions and best practices that bring us into the future of veterinary healthcare, a future that emphasizes a personalized, customized, patient-centered approach.”
Read Cary and Massecar’s article Veterinary Telehealth: What Is It, Where Are We, and What’s Next?