Use It or Lose It: Why the Veterinary Profession Needs to Lead the Telemedicine Movement
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. Although the public may demand the convenience of a virtual veterinary experience, they should be made aware of the limitations of a virtual consultation and the potential risk if specific recommendations are provided in the absence of a physical exam. 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. Like all other emerging fields of the veterinary profession, the patient and client impact of telemedicine will be best understood and most responsibly developed by veterinarians. 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 Center for Connected Health Policy defines telehealth as “encompassing a broad variety of technologies and tactics to deliver virtual medical, health, and education services. Telehealth is not a specific service, but a collection of means to enhance care and education delivery.”1 Many of the current approaches to veterinary telemedicine are not significantly different from e-commerce strategies already employed by most consumer facing industries. If telehealth is viewed from the perspective of a communication method (such as texting or video conference), and the veterinarian must abide by the same regulations as traditional practice, then common sense would suggest no additional regulation is needed. The veterinarian would be responsible for limiting their recommendations based on the detail and type of information that could be acquired and would be held accountable for poor judgement if adverse patient or client impacts occurred. This, however, is not the case, as veterinary telemedicine has been under intense scrutiny and inconsistent regulation since the term first started to appear in the profession.
According to the College of Veterinarians of Ontario (CVO) a veterinary-client-patient-relationship (VCPR) is established when a veterinarian and client agree on a specific scope of services that will be provided by the veterinarian to an animal or a group of animals in accordance with the standards of practice of the profession.2 The CVO also has specific guidance suggesting that a VCPR can be established through virtual means such as telemedicine.3 This decision by the CVO seems both logical and appropriate when you consider the agreement formed between a veterinarian and client regarding advice offered during a telehealth consultation—the veterinarian agrees to listen to the concerns of a client and offer a perspective on which the client will make a more informed decision regarding their animal’s health. Establishing a VCPR alone does not grant a veterinarian with the ability to diagnose or prescribe, as a physical examination is required for each of these activities.
This logical approach to the regulation of telemedicine is unfortunately rare in the profession as many jurisdictions and associations strongly oppose creation of a VCPR in the absence of a physical exam. The American Veterinary Medical Association states that “veterinary telemedicine should only be conducted within an existing veterinarian-client-patient relationship (VCPR)”4, suggesting that the consulting veterinarian needs to have examined the patient prior to a virtual interaction. The AVMA also states that advice given outside of the existence of a VCPR should be limited to general information, and not be specific to a patient, unless given in an emergency situation to assist the client until the patient can be examined by a veterinarian.4 The American Association of Veterinary State Boards (AAVSB) supports this perspective on emergency triage occurring in the absence of a VCPR.5 Both associations also highlight the importance of geographic location of the animal and veterinarian in telehealth circumstances, suggesting that the practitioner needs to hold a valid licence in the same jurisdiction as the animal at the time of consultation. The need for this restriction can be easily supported when considering the human and animal risks associated with zoonotic diseases that are specific to various geographies. A veterinarian unaware of local infectious disease risks specific to a region in which they are not licenced could fail to consider health risks impacting both patient and client.
The current regulatory environment creates a significant amount of confusion and question surrounding telehealth in veterinary practice. Although it is generally accepted and logical that diagnosis and treatment cannot occur without a physical exam, what constitutes a general consultation and when it becomes the practice of veterinary medicine is still very murky at best. Numerous tele-triage services are already in operation and are giving patient specific advice to clients which, by definition, could be considered in violation of current policy and regulation. There is wide variation in the definition, restriction, and acceptance of the practice of veterinary telemedicine throughout North America, with many jurisdictions still holding onto broad-reaching restriction of virtual veterinary-client-patient consultations. If there is one practical and obvious approach that should be adopted by all jurisdictions, it should be the requirement for a VCPR to be in existence or created within all consultations that involve specific discussion of an animal’s current state of health and perceived risks. The VCPR clearly suggests that a service will be held to the same standards of traditional care, holding the veterinarian accountable to professional conduct and evidenced-based methods of practice. Almost every other industry has adapted to the rapidly changing consumer landscape that now views e-commerce as an essential means of customer interaction. Electronic based forms of communication and data collection will continue to integrate into the pet and agricultural markets, and veterinarians have the best array of tools and experience to ensure the integration of virtual interaction with clients is done in a responsible and appropriate fashion.
1. The Center for Connected Health Policy. www.cchpca.org.
2. College of Veterinarians of Ontario. Guide to the Professional Practice Standard—Veterinary-Client-Patient Relationship. Nov 2017.
3. College of Veterinarians of Ontario. Guide to the Professional Practice Standard—Telemedicine. Nov 2017.
4. American Veterinary Medical Association. Policy on Telemedicine. 2017.
5. AAVSB. AAVSB Recommended Guidelines for the Appropriate Use of Telehealth Technologies in the Practice of Veterinary Medicine. September 2018.