Topics

Subscribe

Telemedicine & Its Impact on Veterinary Medicine

Telemedicine & Its Impact on Veterinary Medicine

Telemedicine as a Tool in the Veterinary Practice

Lori Massin Teller, DVM, DABVP (Canine/Feline), CVJ, Meyerland Animal Clinic, Houston, Texas

Telemedicine is currently a hot topic in the veterinary profession. But what is telemedicine, and what does it mean for veterinary professionals and their clients?

Telemedicine is just another tool that can be useful in daily practice to increase client communication, provide client convenience, promote the client’s bond with the practice, and improve patient care. However, just as an ultrasound machine is not relevant to every case, not every case will be appropriate for telemedicine. Veterinarians will need to use good judgement to determine when telemedicine modalities will help them, their patients, and their clients.

At the AVMA Convention in Indianapolis, the AVMA House of Delegates voted to implement a new policy regarding telemedicine. (See Key Highlights from the AVMA Policy on Telemedicine.) See Definitions for the AVMA definitions of telehealth and telemedicine, which will help provide a framework for telemedicine discussions.1 Simply communicating with a client via email, text, or other electronic means is using telemedicine.1

Definitionsa

Telehealth

  • is the overarching term that encompasses all uses of technology geared to the remote delivery of health information or education. In other words, telehealth could be used to describe everything from websites to activity trackers for pets. If a veterinary team updates clients about their pets’ health by using the phone, emailing, or sending and receiving text messages, images, and videos, they are using telehealth tools.  
  • is a subcategory of telehealth in which technology is used to exchange medical information about a patient’s clinical health status from one site to another. The most obvious uses for telemedicine are for diagnosing cases and prescribing medications (eg, a client‒veterinarian video call that replaces a physical visit to the practice).
  • a Definitions adapted from the AVMA Practice Advisory Panel’s final report on telemedicine, published January 2017. 

  • is the overarching term that encompasses all uses of technology geared to the remote delivery of health information or education. In other words, telehealth could be used to describe everything from websites to activity trackers for pets. If a veterinary team updates clients about their pets’ health by using the phone, emailing, or sending and receiving text messages, images, and videos, they are using telehealth tools.  
  • is a subcategory of telehealth in which technology is used to exchange medical information about a patient’s clinical health status from one site to another. The most obvious uses for telemedicine are for diagnosing cases and prescribing medications (eg, a client‒veterinarian video call that replaces a physical visit to the practice).
  • a Definitions adapted from the AVMA Practice Advisory Panel’s final report on telemedicine, published January 2017. 

    When using telemedicine tools, just as when using any other diagnostic or treatment tool, the veterinarian must have an established veterinarian–client–patient relationship (VCPR). The Federal Drug Administration (FDA), along with most states, has specific laws and regulations regarding the VCPR, and practitioners must know what is applicable in their state. In addition, legal liability and responsibility extend to both the state where the practitioner is located and the state where the patient is located.1 (See Telemedicine: The Scale of Legal Implications.) Outside an existing VCPR, any veterinary advice given via electronic means should be general in nature and not specific to the animal’s medical condition, according to a personal communication with the AVMA Professional Liability Insurance Trust. 

    Common Components  

    Teleconsulting (eg, sending radiographs to be reviewed by a radiologist or ECGs to be reviewed by a cardiologist) is a common component of telemedicine that most practitioners use regularly. Emergency teletriage is another important component of telemedicine. Animal poison control services are a prime example, as are potential heat stroke or drowning cases. Although the AVMA supports emergency teletriage until a veterinarian can see the patient, the organization is opposed to remote consulting offered directly to the public when the intent is to diagnose and/or treat a patient in the absence of a VCPR.1 Telemedicine can also be used to monitor herd health or disease outbreaks (eg, avian influenza at a poultry farm) or in times of a natural or manmade disaster. During a disaster, clients and their animals may not have access to veterinary care because roads are impassable, transportation is shut down, or veterinary care is not available at the evacuation facility. A client and his or her veterinarian can use telemedicine tools to manage basic medical concerns (eg, stress-related diarrhea, treatment of minor wounds) until the client can gain access to veterinary care. 

    Telemedicine Toolkit

    The AVMA is creating a toolkit that practitioners can use to further incorporate telemedicine tools into their existing practices. The toolkit will include potential applications, various service model descriptions, case studies, legal and regulatory considerations, equipment resources, and monetization guidelines (ie, many smartphone apps will allow practitioners to charge for their time and services). Further details will be released when the full toolkit is rolled out at the July 2018 AVMA convention in Denver. 

    Applications

    Telemedicine is expected to become increasingly more common in practices,2,3 especially because millennials, who typically prefer electronic communication—particularly text-based—are the largest and fastest growing segment of pet owners.4,5

    Various telemedicine platforms (eg, text, email, smartphone apps) can help veterinary professionals better communicate with clients. For example, consider sending postoperative surgery pictures to let a client know her pet came through with flying colors, or send a client a text to let him know his pet’s urinalysis was normal and the previous urinary tract infection has cleared. These modalities can also be used to further build on the education the veterinary team provides in the examination room (eg, a refresher on new puppy housetraining, instructions for performing a glucose curve at home on a newly diagnosed diabetic cat). 

    Video, another useful aspect of telemedicine, can be pivotal in cases in which determining if the animal is having seizures or syncopal episodes is difficult. In addition, in those common, frustrating intermittent lameness cases, the client can video the pet’s limp and send the video to the veterinarian, who is then able to determine how to localize the problem and where radiographs should be taken to diagnose the cause.

    Article continues after advertisement

    How Communication Pays Off

    • Enhancing client communication, whether traditional or electronic, is one of the top changes that would have the most significant positive impact on the practice.
    • What’s the financial payoff? Enhanced client communication often results in improved client compliance, leading to a stronger average invoice amount. Just a $10 increase for a veterinarian generating 3000 invoices per year would grow revenue by $30 000.

    SOURCE: Benchmarks 2017: A Study of Well-Managed Practices. Columbus, OH: WMPB; 2017:61.

    Conclusion

    None of these problems preclude the need for an established VCPR, a physical examination, and potentially other diagnostics, but the tools of telemedicine can help enhance patient care. Many veterinary professionals are already using these tools every day without realizing they are practicing telemedicine.

    Key Highlights from the AVMA Policy on Telemedicine

    The AVMA Policy on Telemedicine was developed after 2 years of intensive study and input from members and stakeholders. The policy provides a balance between ensuring access to the convenience and benefits afforded by this tool and promoting the responsible provision of high-quality veterinary care. The policy also reinforces that telemedicine should only be conducted within an existing VCPR. The AVMA recognizes that future policies will be evaluated and informed by evidence-based research on the impact of telemedicine with regard to access to care and patient safety. 

    The AVMA recognizes the need for emergency teletriage services (eg, poison control) but is otherwise opposed to remote consulting offered directly to the public when the intent is to diagnose and/or treat a patient outside an established VCPR. A veterinarian who has an established VCPR, however, has the professional discretion to consult with specialists or other experts, and the consultant should not be required to hold a license in the state where the veterinarian with the VCPR practices or where the patient resides (ie, the veterinarian with the VCPR should be able to have a radiologist in another state read a patient’s radiographs). 

    Telemedicine guidelines should be harmonized across the nation and strongly enforced to protect patient and public safety. The AVMA supports regulatory efforts to clarify where the actual practice of veterinary medicine occurs when offered through telemedicine modalities, who has regulatory enforcement and disciplinary authority, and what remedies are available in case of patient harm. 

    Eligibility to provide telemedicine services should be restricted to those people who are legally authorized to practice veterinary medicine in that state, and the credentials of all advice givers, as well as any disclaimers, should be unambiguous and clearly displayed. Clients should be aware of the advice giver’s identity, location, licensure status, and potential privacy and security issues with electronic communications. 

    Finally, the AVMA policy states that the legal accountability, liability, and responsibility of the practicing veterinarian should be in both the state where the patient is located and the state where the veterinarian is located.

    1 Be familiar with the definition of VCPR in the state where you practice.

    2 Document any telemedicine services in the medical record in the same manner as traditional professional services.

    3 Do not be afraid to add telemedicine services to your practice to improve patient care and bond clients to your practice.

    4 Be familiar with your state’s legal telemedicine requirements.

    References and Author Information

    Material from Veterinary Team Brief may not be reproduced, distributed, or used in whole or in part without prior permission of Educational Concepts, LLC. For questions or inquiries please contact us.

    Practice Tools

    Topic

    Technology

    Veterinary Team Brief delivers practical skills for team-based medicine—with clinical strategies for team training, peer-reviewed credibility, concise content, essential training modules, and easy-to-implement protocols. From the publisher of Clinician's Brief.

    © 2018 Educational Concepts, L.L.C. dba Brief Media ™ All Rights Reserved. Privacy Policy (Updated 05/08/2018) Terms of Use (Updated 05/08/2018)