General Manager, Associated Veterinary Purchasing Company, Langley, BC, Canada
Telemedicine is currently viewed by many in the veterinary community as a potential threat to the traditional approach to general practice. Almost every industry today has evolved to quench the consumer’s growing thirst for e-commerce, yet the veterinary space has specific complexity which requires careful consideration. Regulation of this new branch of veterinary practice will be essential to ensure that telemedicine delivers the quality and professionalism required by other veterinary disciplines, yet not regulated in ways that unnecessarily restrict access to virtual services that are in obvious and growing demand. When operating within the confines of good medical practice, veterinary telemedicine will increase access to quality care, improve communication with clients, and ensure that our profession remains relevant to an increasingly tech-savvy consumer.
The most common type of veterinary telemedicine is telehealth or triage, assisting clients in determining the urgency and severity of an animal health concern. Successful triage ensures that animals in immediate need of medical attention are not ignored by clients hoping the clinical signs will spontaneously resolve and directs non-urgent cases to seek care from their regular veterinarian during normal clinic hours. In a profession that is demanding improvements in wellness and work-life balance, preventing non-urgent caseload from arriving at emergency centres, or the waiting room of fully booked clinics, is key to adapting our profession to the needs of future practitioners. In addition, considering that many pet parents have limited financial resources to dedicate towards veterinary expenses, helping these clients to avoid unnecessary emergency fees could potentially save resources better allocated toward diagnostics and procedures during regular business hours. Any veterinary facility licensed for companion animal practice has the resources to offer telehealth or triage services to their clients, and some use existing staff to offer out-of-hours advice. Alternatively, using an external veterinary telehealth service holds the obvious benefit of reducing staff out-of-hours responsibilities and ensures that calls are handled by personnel that are familiar with the telehealth environment, and the associated risks and nuances specific to veterinary telehealth and triage.
Many of the emerging approaches to telemedicine in veterinary practice cater to companion animals and are very similar in scope and purpose to e-commerce approaches already being used by most consumer facing industries. The public expects the convenience and accessibility of instant communication through smart phones and online, and the veterinary profession will need to adapt to these ever-evolving consumer desires. Fortunately, some veterinary regulatory bodies recognize this trend and are adapting specific policy and guidelines surrounding telemedicine in veterinary practice.1,2 As a physical examination cannot be performed remotely, traditional veterinary practices should not view telemedicine as holding any significant threat of competition with their current business. In fact, offering a veterinary telehealth service to a veterinary client base can direct simple inquiries, triage, and discussion-only type interactions away from hospital-based veterinarians that should focus on traditional patient care. The interaction between traditional veterinary practice and veterinary telehealth can therefore be argued as one of symbiosis versus one of competition.
Virtual client interaction strategies are equally valuable following a traditional veterinary appointment or procedure. Accessibility to audio, video, and text-based communication applications online and through smartphones makes virtual communication with clients extremely easy and efficient. The use of telemedicine to augment traditional care can be seen in post-surgical evaluation, evaluation of disease progression or therapeutic success, and palliative care. When appropriate, which is highly case dependent, providing the option for a virtual interaction versus a traditional clinic visit holds numerous benefits. Virtual visits do not require a sanitized examination room, they occupy no space in the appointment book or waiting room, and timing can often be quite flexible. Sick and elderly patients can avoid travel to and from a hospital environment, and busy clients have more times available for consultation. In theory, the application of telemedicine approaches to traditional veterinary care is only limited by the creativity and investment of the veterinary practice.
Telemedicine is not immune to the potential for error, risk, and the associated liabilities. There are three fundamental areas of risk for consideration during any telehealth consultation: the risk of inferring a diagnosis, the risk of suggesting a treatment, and the risk of client involvement in physical assessment. It is common for a client to ask a telehealth provider whether a traditional veterinary approach is needed and if a general diagnosis and treatment option can be suggested or attempted prior to a full examination. Diagnosing and making therapeutic recommendations without a physical exam are not only irresponsible, they are prohibited in almost all regulatory jurisdictions.
Veterinarians should discuss risk factors, potential outcomes, and level of urgency so that the client can decide when they will seek veterinary attention. During such consultations the veterinarian may be tempted to involve the client in diagnostic evaluation, such as palpating a sore leg, or looking into an itchy ear. The telehealth provider is viewed as a person of knowledge and authority, so it seems reasonable that a client would follow their recommendation without considering the potential risks at hand, and if bitten or scratched, it would seem equally reasonable to hold the provider accountable for any injury or damages that occur. Privacy and data security regulations vary widely between jurisdictions and veterinarians should always seek to understand the requirements associated with conducting virtual client interactions.
Telemedicine is not unlike other aspects of veterinary practice and offers significant benefits to clients and to the practice of veterinary medicine, but not without risk when done carelessly or without evidence-based process. Consumer demand for convenience, coupled with the rapid rise in pet technology and e-commerce, will be a strong driver for the development of telemedicine in the veterinary space. All stakeholders in our profession need to be advocates for the adoption of more technologically savvy approaches to client interaction, with equivalent emphasis on the need for an evidence-based approach prior to widespread adoption. Ensuring our profession keeps pace with emerging trends in e-commerce and customer interaction will be essential to remain relevant to the client, however, this must be done in ways that preserve the quality of veterinary practice and ensure both client and patient safety.
1. College of Veterinarians of Ontario. Guide to the Professional Practice Standard—Veterinary-Client-Patient Relationship. Nov 2017.
2. College of Veterinarians of Ontario. Guide to the Professional Practice Standard—Telemedicine. Nov 2017.