“A Veterinarian using Telehealth must take appropriate steps to obtain Informed Consent, establish the VCPR and conduct all appropriate evaluations and history of the patient consistent with traditional standards of care for the particular patient presentation. As such, some situations and patient presentations are appropriate for the utilization of Telehealth as a component of, or in lieu of, hands on medical care, while others are not.”
- American Association of Veterinary State Boards (AAVSB)
Virtual Care is more applicable than many believe, with features such as text, email, and internet platforms making it more accessible to every day practices. Currently, the VCPR must be established with hands on physical exam by the veterinarian in most states (D.C., Connecticut, and Alaska having no specific provision). Having said that, every day specialists consult with veterinarians and clients over virtual care platforms like email or consult programs without having to perform a physical exam.
Why can some veterinarians effectively give a diagnostic opinion without a VCPR but the general practitioner veterinarian cannot?
Most of the push back against virtual care is due to a misconception that the veterinarian will be expected to diagnose patients from afar and veterinary professionals will no longer have the hands-on aspect that is so highly valued in veterinary care. However, it is completely up to the veterinarian, when using virtual care tools, to decide whether or not the patient needs to come in for further work up. Using virtual care tools, issues like fleas, behavioral questions or consults, and wound rechecks could be done with a text message of a picture or video and more complicated cases like possible diabetes, Cushing’s, or masses would be instructed to schedule an appoint or immediately seek care with an emergency clinic.
It is important to distinguish that virtual care tools are not meant to replace the in-person examination but rather to expand the services and efficiency of the hospital. For example, there are wearable collars that track the activity of the patient, following things like scratching, eating, drinking, and urination. Imagine as we collect that data and can see the slight changes in the pets’ behavior, how much earlier we will begin to treat diseases. Veterinarians will have the opportunity to be more efficient with their time, see more patients, and meet the needs of the new generation of clients.
Taking this one step further, currently the AVMA allows telemedicine triage without the establishment of a VCPR (ie. Giving medical advice over telephone for an emergency patient). If we are willing to trust the veterinarian's judgement in a high stress, emergency situation, why shouldn’t we trust veterinarians with the everyday patient care over virtual platforms?
whiskerDocs has shown that there are roughly 2.2 billion animals who are underserved annually and that number is growing. Embracing technology is the first step to reaching those underserved clients which, prior to now, were untapped revenue. The new model of veterinary care is similar to the current state of human medicine in that licensed veterinary nurses will allow veterinarians to remotely practice a high level of care. Digital care tools will not only save veterinarians time but it will make them money if they are willing to take advantage of what is becoming available. Consequently, the practices that do not embrace the innovations coming into the profession will become outdated and left behind.
Canada, specifically Ontario, has already passed a policy that allows for the VCPR to be established without the veterinarian having to perform a physical exam on the patient. The importance of gathering all other provisions normally collected to establish a VCPR, such as a history and patient records is still emphasized with the difference being the means by which the information is acquired. Rather than having the client and patient come into the clinic to present the history and records in-person, the client can do so electronically, which can be extremely beneficial for patients such as fractious cats and geriatrics. Furthermore, a credentialed veterinary nurse could be deployed to the home of the fractious cat or geriatric patient and remotely communicate with the veterinarian from the patient’s home. Should the veterinarian deem the virtual appointment inadequate to properly serve the patient, then an in-house appointment can be scheduled.
Routine procedures like anal gland expression, pilling a cat, or administering fluids can all be remotely performed by a registered veterinary nurse.
Consider that nurses in human medicine have been heavily utilized in both basic patient care and follow-up care with remote access to a doctor for some time now. In contrast, the current practice acts in most states do not permit veterinary nurses to perform these procedures in home unless the veterinarian is there in-person supervising. Should the regulations change and allow registered veterinary nurses to practice select procedures with access to a veterinary consult, the profession could more easily reach the 2.2 billion animals who are currently not served. Not only that, but with the broad use of veterinary nurses, cost of services can be reduced making more clients willing and more able to participate in basic wellness practices and animal care.
The next steps for veterinary medicine are for veterinarians to begin implementing virtual care into their practices. Legislation must allow veterinarians to choose when they have sufficient information to diagnose and prescribe based on what is best for the patient, not what is best for the law. Legal changes take time.
In the meantime, every patient with a current VCPR can be diagnosed and prescribed using virtual care tools.
In the near future, the practices that have digital health available to their clients will stand out among the competition, drawing more consumers into the clinic. The Veterinary Innovation Council is creating a resource guide for helping veterinary practice owners find the companies they need to embrace and implement virtual care products. Digital care is already so expansive and yet it is only the tip of the iceberg.
Future issues that need to be considered include virtual care consults across state lines. Currently the legislation does not clearly state the legality of a veterinarian giving medical care to a patient in a different state. However, with the use of digital care it allows for the opportunity to access the best specialists and veterinarians, regardless of where they are located in the world. Not only that, but veterinarians that offer particular services not accessible in every state will have the means to reach patients that are outside of a specific radius of the practice. The rules and regulations on matters of across state medical care are not clearly defined and will need to be considered with the expansion of digital care.