Science fiction has long portrayed advances in medical care years or decades before they are developed in real life, if they ever are. One such depiction, often taken for granted in a futuristic environment, is the ability to deliver medical care remotely.
Over the last number of years, this has moved firmly from the realm of science fiction into the realm of fact. While we can't exactly remotely dispense medication, perform remote surgeries, take x-rays or other imaging from a webcam, or do remote laboratory diagnostics, there are other services that can be performed remotely with little or no reduction in standard or quality of care.
While the advent of telehealth and telemedicine was years ago in human medical care, veterinary care – as usual – tends to lag a number of years behind. Thankfully, it's now catching up.
What Are Telehealth and Telemedicine in Veterinary Care?
You've likely seen terms like telehealth and telemedicine thrown around more or less interchangeably. They refer to the same general concept, after all. However, they technically have some differences.
Telehealth is the overarching term for any remotely provided medical care and services for both human and animal patients.
Telemedicine, meanwhile, is a narrower, more specific portion of that overarching concept. Telemedicine refers to the use of tools like webcams or phone video calling, software like Skype or Zoom, and other means of communication to provide medical examinations, care, and advice.
Veterinarians can examine a patient, at least on a surface level, and can use that information to advise the pet owner what the next steps they should take would be.
"Telemedicine is a tool of practice, not a separate discipline within the profession." - AVMA.
There are other components of telehealth as well. They include but are not limited to:
Teleconsulting, which is using telecommunications to consult with other veterinary specialists who would otherwise need to be there in person to offer an opinion.
Telemonitoring, which is the use of devices connected to communications services to provide ongoing monitoring. For example, an internet-connected glucose monitor.
Teletriage, which uses telehealth channels to help patients determine whether or not they should seek immediate, emergency treatment or if an issue can wait for an appointment.
E-Prescribing, which is the ability to write prescriptions remotely (and, in some cases, even have medications mailed to a patient.)
In many ways, telehealth is the next major step in veterinary care, though, of course, it brings with it many unique challenges.
What Are the Benefits of Veterinary Telehealth?
Telehealth and telemedicine in veterinary care offer a handful of very valuable benefits, both to patients and to vets.
Vets can see more patients more quickly. A telehealth appointment can be fast and can even be worked in between regular appointments, especially for things like brief checkups and other surface-level check-ins. This saves both the vet and the patient time and money. There are also studied benefits showing that telehealth services reduce fatigue and stress on vets, which is always a good thing given their ongoing mental health challenges as a career.
This also reduces potential time consumption on the part of patients; if they don't need to gather up their animals and transport them to a vet potentially quite a distance away, they save time and can have a more convenient appointment. This has the added effect of increasing patient satisfaction and, consequently, retention (client turnover reduced from 13% to 3%, per NCBI).
Teletriage helps assuage the anxiety of a potential issue in pet owners while lightening the loan on emergency vets who would otherwise need to handle non-emergencies coupled with anxious and potentially angry pet owners.
Telemedicine does not fully take the place of traditional medicine, of course. There's still a lot that can't be done remotely, including close examination of acute issues or management of chronic conditions. Similarly, if any sort of testing or imaging needs to occur, it can't be done remotely.
That said, many vets spend a lot of time each day reassuring stressed patients that their animals aren't in as bad a shape as they fear, checking up and following up on cases that don't necessarily require the patient to be there in person, and more. All of this can be done remotely, freeing up that time and in-person space for more critical patients.
Finally, telemedicine can be beneficial for many animals, particularly animals that have difficulty moving, have anxiety or stress issues relating to car rides or vet offices that have other animals in them, and animals with other compelling reasons why it would be better if they were allowed to remain in the comfort of their own homes. In the past, these animals would either require a house call (a rarity these days) or would simply go without care in far too many cases.
"Many dogs and cats experience fear, anxiety, or stress during clinical veterinary examinations. Research shows that pets can become so frightened at the vet's office that they will not enter exam rooms willingly and must be physically carried or dragged. Dogs and cats are sometimes separated from their owners for medical exams, which can cause the pet even greater stress. Owners of fearful pets may postpone or forego clinic visits because they wish to avoid causing their pet undue stress." - ASPCA.
This can be especially relevant for cats, which are creatures of routine, generally dislike being trapped against their will, and are often difficult in a veterinary setting.
"Several experts I spoke to say cats rarely, and in some cases never, get veterinary care because of how hard it can be to put a cat in a carrier and how stressful the experience can be on them. Cats still need to go to the vet, no matter how much of a struggle it is, but telemedicine opens up a world for cat owners to show a veterinarian what's going on when they're in their own home." - Wired.
Opening up additional avenues of care for underserved animal populations is a huge benefit of telemedicine in veterinary care.
Is Telemedicine Legal in Veterinary Care?
Part of the current challenge in veterinary telemedicine is that it's not broadly approved across the country or around the world.
In order to provide veterinary care, a vet must establish a VCPR, or Vet-Client-Patient Relationship.
"A VCPR is present when all of the following requirements are met:
1: The veterinarian has assumed responsibility for making clinical judgments regarding the health of the patient, and the client has agreed to follow the veterinarian's instructions.
2: The veterinarian has sufficient knowledge of the patient to initiate at least a general or preliminary diagnosis of the patient's medical condition. This means the veterinarian is personally acquainted with the keeping and care of the patient by virtue of a timely examination of the patient by the veterinarian or medically appropriate and timely visits by the veterinarian to the operation where the patient is managed.
3: The veterinarian is readily available for follow-up evaluation or has arranged for the following: veterinary emergency coverage, and continuing care and treatment.
4: The veterinarian provides oversight of treatment, compliance, and outcome.
5: Patient records are maintained." - AVMA.
In order to dispense drugs extra-label, issue a vet feed directive, or use certain types of biologics, this VCPR must be established by federal law. State laws also vary but follow the same tracks.
As is so often the case, laws and legislation lag behind technological advancement. As it stands, only New Jersey, Virginia, Idaho, and Arizona have specific laws permitting veterinary telemedicine. Meanwhile, Florida and New York don't address it at all, and every other state either prohibits or doesn't allow for it without specifically prohibiting it.
"Without an established VCPR – The veterinarian may provide general advice but must specifically stay clear of diagnosing, prognosing, or treating patients. Advice should not be specific to an individual animal, diagnosis, or treatment. Non-client electronic communications should be in the non-clinical realms of general advice, mHealth, web content, and other generalized messaging." – AVMA.
So, while it's frequently not illegal to provide veterinary telemedicine services, there's very little that you as a vet can actually do, especially for patients you haven't seen before. Once a VCPR is established, you can provide more specific follow-up care, however.
The other legal consideration is licensing, so vets are encouraged to only provide telemedicine services to residents of states where they are licensed.
How Your Practice Can Implement Telemedicine
If you're a vet and you're interested in adding telemedicine services, there are a few things to do.
First, make sure it's legal where you are. You may want to consult with a lawyer just to be especially sure. Moreover, you want to know what potential restrictions you may have, including whether or not you need to see a patient in person first to establish your VCPR.
Next, determine what kind of telemedicine services you want to provide. General examples include:
Teletriage to help pet owners in danger decide what action to take and whether or not they need to rush their animal to an emergency vet, schedule an emergency appointment, take active precautions and provide home care, or just keep an issue in mind for the next regular appointment.
Post-treatment follow-up and check-in services to ensure no complications are arising and, if necessary, to take action if they are.
Regular prescription renewal and review.
Some services, like examinations, critical care, dermatology, and oncology, can be virtually impossible to handle remotely. You can't exactly take a blood sample, examine a lesion, or palpate a lump from the other side of a screen.
At this point, you have a choice to make. You can set up your own telemedicine system, or you can consider partnering with an existing system. There are a lot of services springing up that help provide veterinary telemedicine services with their own infrastructure. Companies like TeleVet, Chewy Connect, Pawp, Dutch, Airvet, Buddies, PetDesk, and AskVet all offer some level of services for pet owners, and they need vets to be able to provide those services. You'll need to evaluate each program and see which one works best for your practice.
If you choose to set up your own system, you'll need software to do so. While this can be handled simply over a tool like Zoom or FaceTime, there are also software options designed specifically for vets. Apps like Digitail, Vetstoria, EzyVet, PetsApp, and Vetport are all just some of the many potential options.
From there, it's a matter of setting up your platform of choice, testing it to ensure that it works as broadly as possible, and developing a smooth, graceful backup if it fails or doesn't work for individual patients and clients.
After that, all that's left is to market your use of the telemedicine system and make use of it.
Need Consulting and a Second Opinion?
At Hope Vet, what we do isn't quite telemedicine. It's closer to teleconsulting, as mentioned above. We maintain a staff of veterinary experts in a variety of areas of veterinary medicine, including:
Oncology
Neurology
Internal Medicine
Dermatology
And we're always available for consultations and second opinions. Whether you're in over your head and you aren't sure what the right move is, or you're just looking for a second opinion to give your patients peace of mind, we're here to help.
On top of that, we take vet mental health seriously. If you're struggling, or someone on your team is, our dedicated coach can help offer strategies for preventing and alleviating stress and mental health challenges, along with coping strategies and more.
Telecommunications open up incredible new avenues for medical and veterinary care across the board. While we all collectively wait for the law to catch up, it's a good idea to establish systems that can handle anything we're currently able to provide to better serve our communities. We're here to help, so give us a call or request a consult whenever you need assistance. And if you have any questions, please feel free to let us know at any time!