Telemedicine: Meritable Change or Miscalculated Risk to the Veterinary Profession?

Gregory, the skittish Bengal, dodges his owner’s grasp and dashes under the inaccessible corner of the bed. Frustrated, the owner grabs his phone and calls the clinic to let them know that they will have to reschedule, once again. It’s been years since Gregory has been into the clinic for his wellness check and that does not appear to be changing anytime soon. Luckily for them, there may be a different way for Gregory to get some face time with a veterinarian…

The use of Telehealth in veterinary medicine is not as novel as many believe. The AVMA classifies “Veterinary Telehealth is the use of telecommunication and digital technologies to deliver and enhance veterinary services…” meaning that simply calling a client over the phone can be considered Telehealth.1 Recently, there have been efforts to expand the use of telemedicine as well as alter the criteria for establishing a veterinary client patient relationship (VCPR). The “Telemedicine” that likely comes to mind penetrated the veterinary profession in 2016 when the North American Veterinary Community created the Veterinary Innovation Council.2 The American Association of Veterinary State Boards took interest in this initiative and formally voted to adopt a model telemedicine policy in 2018 outlining the guidelines for the appropriate use of telemedicine in veterinary practice.2 These guidelines addressed the licensure of veterinarians, evaluation/treatment of patients, continuity of care and medical records, emergency services, prescribing medications, and telemedicine service requirements.2 These guidelines set the framework for the use of telemedicine in a veterinary setting and each state had the ability to determine how the telemedicine VCPR would be addressed.

Ontario, Canada has demonstrated how Telehealth can flourish in veterinary medicine. Veterinarians in Ontario began using telemedicine two months into the provincial shutdown and 81% of practices continued to utilize Telehealth after the pandemic.6 Many of those who opposed the virtual formation of a VCPR believed that adverse patient outcomes would occur but after two years, the College of Veterinarians of Ontario has yet to receive a single complaint associated with the use of telemedicine.6

When used appropriately, telemedicine can augment traditional veterinary care. Clients that reside in veterinary resource desserts will have the ability to communicate with a veterinarian about their animal and then determine if the animal needs to be brought into a clinic. ASPCA’s senior director of state legislation for the Western division mentioned, “when used responsibly, veterinary Telehealth can help reduce animal suffering, address barriers to care, keep pets in their homes, and extend the capacity of animal shelters to serve animals and their communities by increasing access to veterinary care.”3

Telemedicine may also provide a sense of relief for those with pets that are difficult to bring into a clinic due to behavioral issues, size, or owner’s physical ability. Owners may be able to utilize this service for minor issues while eliminating the stressful aspect of physically bringing in their animal. A virtual visit may also be an appropriate way to talk to an owner about the animal’s quality of life. Oftentimes, as an animal gets older, they begin to have mobility problems, or are more anxious while riding in a car or going to new locations. The ability to talk to owners about an animal’s quality of life over a virtual format will allow the veterinarian to assess the animal in its natural habitat which may allow them to gain a more accurate assessment of the animal’s overall wellbeing.5 Generally, when an animal comes into the clinic they are in a heightened state, and this may not provide the most realistic representation of their actual health. Telemedicine may also allow for access to a specialist that may not reside locally which can improve the level of care an animal receives.

On the opposite side, there are a few things to be wary of while practicing telemedicine in a veterinary setting. The level of care is expected to remain the same meaning that veterinarians are held to the same standard whether they are seeing the pet in person, or virtually.2 This is important to consider since veterinarians use a multitude of senses while examining their patients. Smell, touch, taste, and hearing (specifically auscultation) are out of the picture while practicing through an online platform. Taking away these vital senses gives you limited options while doing a “physical exam” virtually. There is also the possibility that the technology being used to conduct these virtual interactions will not transmit information in a sufficient way, for example poor video resolution, or general failure of the equipment. An additional consideration should be given to the potential beach of client/patient privacy if online security protocols fail.3         

I personally believe that telemedicine has a time and place in the veterinary field, but careful consideration should be given to the way that it is implemented. Veterinarians must be aware of their state’s laws regarding the practice of telemedicine and the rules regarding the VCPR formation. They must also use their judgement to determine if they have enough information through a digital encounter to initiate care for a patient since telemedicine cannot be a scapegoat for substandard care.2 Open communication with clients on the potential limitations of telemedicine and the possibility that they will need to come into the clinic for an in-person exam is crucial and can mitigate problems down the road if the animal does have to be seen in-person.2 A handful of states have already allowed a VCPR to be formed virtually and California is quickly following as of January 1, 2024.1 This is a personal matter and should be done at the discretion of the practicing veterinarian. In order to further mitigate potential risks, veterinarians should ensure that they have the proper technology platform to deliver these services and screen the owners ahead of time to ensure this communication method will be successful. They should ensure that they factor in some “buffer” time for technological issues so that scheduling does not interfere with their other patients and that their security protocols are also aimed at protecting client information.

With proper collaboration between veterinary professionals, clients, and patients, the use of Telehealth practices may allow for veterinary care to be more accessible and decrease stress associated with veterinary visits!

Resources:

1.     AVMA Guidelines for the Use of Telehealth in Veterinary Practice, www.avma.org/sites/default/files/2021-01/AVMA-Veterinary-Telehealth-Guidelines.pdf. Accessed 31 Dec. 2023.

2.     Cushing, Mark. “What Is Telemedicine, Telehealth, and Teletriage.” The Veterinary clinics of North America. Small animal practice vol. 52,5 (2022): 1069-1080. doi:10.1016/j.cvsm.2022.06.004

3.     “Gov. Newsom Signs Bill for Accessible Vet Telehealth.” San Diego Humane Society, www.sdhumane.org/about-us/news-center/stories/ab1399-passes.html. Accessed 31 Dec. 2023.

4.     Mulherin, Brenda L, and Kristin M Bannon. “Communication, Veterinary-Client-Patient Relationship, and Teledentistry.” The Veterinary clinics of North America. Small animal practice vol. 52,1 (2022): 25-47. doi:10.1016/j.cvsm.2021.08.002

5.     Shea Cox, Telehealth in Hospice and Palliative Care, Veterinary Clinics of North America: Small Animal Practice, Volume 52, Issue 5, Pages 1123-1133, 2022

6.     The Current State of Telemedicine in Ontario - Vvca.Org, vvca.org/wp-content/uploads/2020/11/Telemedicine_in_Ontario.pdf. Accessed 31 Dec. 2023.