Telemedicine is not a new thing in veterinary medicine. By its broad definition, whenever a general practitioner vet emails diagnostic images to a radiologist for a consultation, or a large animal doc transmits a medical record to his office from the field where he did the exam, that’s telemedicine. But not surprisingly, these days it has begun to evolve. The same factors that are driving the rise of internet-based video visits for people are at play in the veterinary world. Using video visits for animal care is not without controversy. The American Veterinary Medical Association (AVMA) is working to shape the future of telemedicine in veterinary care.
At present, most state laws require the establishment of a veterinarian-patient-client-relationship (VPCR). This is supported by many veterinarians who argue that, while it may be appropriate to establish a doctor-patient relationship for a human without an in-person exam, the treatment of animals is not the same. Diagnosis is more difficult because of the animal’s limited ability to communicate and even the most well-meaning pet owners can misunderstand their pet’s symptoms.
One veterinarian in Texas disagreed. In 2013 Ron Hines filed a lawsuit after receiving a disciplinary action by the Texas Board of Veterinary Medical Examiners for giving medical advice via phone and email for pets he had not examined in-person. Hines argued that this was a violation of his right to free speech. The Texas court did not concur, citing the public health interest of requiring a veterinarian-client-patient relationship. The Supreme Court refused to hear the case.
But as with telemedicine for humans, technologies and comfort levels are evolving.
AVMA Advisory Board
In 2016, the American Veterinary Medical Association asked one of its advisory panels to look into the role of telemedicine in the veterinary field. The association doesn’t currently have a policy on telemedicine exactly, but its model practice act states that a veterinarian-client-patient relationship “cannot be established solely by telephonic or other electronic means.” The board was asked to make recommendations to help establish the veterinary profession’s standard for responsible use of telemedicine through possible AVMA policies, best practices, guidelines, and resources.
The Telemedicine Subcommittee consisted of five working groups that sought input from more than 50 volunteers. The Practice Advisory Panel presented its final report to the Board of Directors in January 2017.
The AVMA is now asking for input on this report. They are especially interested the recommendations regarding the AVMA’s Model Veterinary Practice Act and the policy on Remote Consulting. The report has not been adopted by the board and is not AVMA policy.
The board recommends that “telemedicine shall only be conducted within an existing VCPR, with the exception for advice given in an emergency care situation until that patient(s) can be seen by or transported to a veterinarian. Without a VCPR, telemedicine should not be practiced, and any advice given should remain in general terms, not specific to an individual animal, diagnosis, treatment, etc.”
In other words, the recommendation is that an in-person relationship be established before telemedicine is used with the exception of emergency care, such as animal poison control services.
However, the advisory panel is not at all against incorporating telemedicine as a tool in veterinary medicine. In fact, the report states, “The AP recognizes that as technologies advance and as long as face-to-face virtual encounters are guided by the same regulatory and ethical principles of in-person encounters, utilization of telemedicine services does not represent an ethical threat to veterinary best practices.” The report even offers some useful telemedicine checklists for practices.
Telemedicine’s Use in Consulting
Telemedicine has long been used for veterinary consulting. The advisory panel is strongly in favor of this approach. “Such teleconsulting should be allowed to continue and to utilize ever-increasing technologies for the betterment of patient care.”
Examples of teleconsultations include:
- Electronic conversations by telephone, video teleconferencing, texts, etc.
- Transferring/sharing electronic records, diagnostic images, ECGs, etc.
- Telecardiology, teleneurology, telepathology, teleradiology, etc.
- Consulting with a nutritionist, toxicologist, pathologist, clinician, or other subject matter expert
Today, some state licensure restrictions require that only consultants licensed to practice veterinary medicine within the state may consult within the state. The advisory panel disagrees with such intrastate licensure restrictions, finding them unnecessary.
It is great to see the organization take a thoughtful, considered approach to how telehealth can help make all of our pets and livestock healthier. If you are a veterinarian, it is worth giving the report a review and sharing your comments, which are due by March 16, 2017.