Telehealth: Navigating the New Normal

Telehealth has been a topic of conversation in the veterinary community for several years. Some veterinarians wholeheartedly embraced the technology from the beginning. But many, including myself, remained skeptical about how it could work in a medical field where patients cannot speak and practitioners rely on the physical examination for vital information.

In March 2020, the practice of veterinary medicine rapidly shifted in the wake of the COVID-19 pandemic. As state governments limited service offerings and advised social distancing, we worked quickly to adapt to a new normal and found creative ways to interact with our clients.

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Suddenly, a technology that had been present for years became very attractive. In some states, it became a necessity for clinics to stay open. The technology provides an alternative way for veterinary teams to interact with their clients, but as with any tool, we must understand the best ways to use it in order to get the most out of it and maintain a high standard of care.

What is Telehealth?

Many of us have been engaging in telehealth activities for years, whether we were aware of it or not. Every time we picked up the phone to consult with a specialist, requested a radiology consult, reviewed a photograph of a pet’s incision, or wrote an e-prescription or veterinary feed directive, we practiced telehealth.

The AVMA defines many terms related to telehealth.¹ The most common terms that apply to everyday practice include:

• Telehealth is the broadest term and encompasses all use of technology to provide remote communication and patient care.
• Telemedicine is a subcategory of telehealth that applies to virtual information sharing related to a specific patient for which the veterinarian has an existing veterinary-client-patient relationship (VCPR).
• Teletriage is used in a potentially urgent situation and allows a veterinarian to advise a client whether their pet needs to be seen immediately based on the client’s report of medical history and clinical signs. Teletriage may or may not include a visual assessment of the patient by photo or video and does not require an existing VCPR.

The AVMA’s current Telemedicine Policy, which was adopted in 2017, states that telemedicine should only be performed within an established VCPR, unless the veterinarian is providing emergency advice before a pet owner arrives at a veterinary hospital.²

The Elephant in the Room: Establishing a VCPR

The VCPR is at the core of the practice of veterinary medicine and historically has been established through an in-person physical examination of the patient and maintained by annual physical examinations. The VCPR is defined both by the Food and Drug Administration (FDA)—for purposes of extra-label drug use or writing of veterinary feed directives—and by each state’s veterinary board.

Questions arose as to whether a VCPR can be established or maintained virtually. While some states discussed allowing virtual establishment of a VCPR, the AVMA’s model practice act states that “a veterinarian-client-patient relationship cannot be established solely by telephonic or other electronic means.”³

During the COVID-19 pandemic, the FDA and some states temporarily altered their definitions of VCPR to facilitate the use of telemedicine. These alterations include extending the time between physical examinations required to maintain a VCPR or waiving the physical examination requirement altogether.

At this time, the original requirements of the VCPR are expected to resume after the pandemic. However, the precedents that these alterations may set could shift the future legal landscape surrounding veterinary telehealth.

How Can Telemedicine Be Used?

One of the most fascinating aspects of telemedicine is its versatility. Some veterinarians have set up “do-it-yourself” models using existing video-conferencing software. They may incorporate an online scheduling program or have clients call the office to set up an appointment. Others have taken advantage of the numerous telehealth platforms that are available. These programs integrate the scheduling, payment, and communication, whether through text conversations or video chats, all in a single app or program. Some interface with practice management software, improving their ease of use.

There are many types of services that can be offered to clients via telemedicine, no matter what technology is utilized to accomplish the virtual visit. Examples of cases where telemedicine can be used include:⁴

• Post-operative healing checks
• Quality of life consultations
• Oral health evaluations
• Evaluation of mild dermatologic infections
• Progress examinations for dermatology cases, wound healing, or management of chronic conditions such as osteoarthritis or diabetes
• Evaluation of the severity and urgency of acute conditions including vomiting, diarrhea, or lameness

We have offered many of these consultations via phone for years, often at no charge. Our profession is notorious for undervaluing our time and services, and utilizing a telehealth platform can enable us to capture revenue for these consultations.

Given the important information that is gained from physical examinations and diagnostic testing, it is expected that some of these consultations will result in a recommendation for a visit to the office before a definitive diagnosis can be made or treatment prescribed. Preparing clients for this possibility at the time the consult is scheduled is essential to a successful visit and client satisfaction.

Client Perceptions

Anecdotal reports from many veterinarians who currently engage in telemedicine state that clients are willing to pay for the increased contact with their veterinarian. In a survey of clients who engaged in an online telehealth platform independent of a clinic, over 90% of respondents who had a traditional veterinarian stated they would utilize a telemedicine service if their veterinarian offered it.⁵

Sixty percent of the consultations in this survey resulted in a recommendation for an in-person visit for a full physical examination and diagnostic testing.⁵ For those who followed up with their regular veterinarian, the majority felt that they were both better prepared for the visit and better able to communicate about their pet’s problem. They also reported that over 80% of the time their veterinarian agreed with the recommendation received from the third-party telehealth platform. The top reason for not following up with a veterinarian as recommended was financial limitations. This survey provides some of the first evidence-based data to support client interest in telemedicine.

Veterinary Medicine of the Future

With the explosion of telehealth usage and resources during the COVID-19 pandemic, the profession is looking at a changed landscape. Telehealth is now a part of many practices, and its use will likely continue to grow. More evidence-based research into telehealth usage by veterinarians and clients is needed, and the legal landscape surrounding telehealth will continue to evolve. Only time will tell what telehealth will look like in the future.

Veterinarians are accustomed to being introduced to new products and technology as medicine advances. We have watched as new drugs, diets, vaccines, and parasiticides have improved our ability to treat chronic conditions such as atopy, prevent flea infestations, and reduce infectious diseases. We know how to critically evaluate the literature surrounding these new products and select patients who will benefit. We must now use these same skills to evaluate telemedicine and determine how we can use it to improve client communication and expand on patient care.

Those who want to learn more about implementing telehealth in their practice can utilize the AVMA Telemedicine Resource Center¹ and the Veterinary Telemedicine Community⁴ on Facebook, run by Dr. Jessica Vogelsang.