Telemedicine

Comment on this policy

Telehealth is the overarching term that encompasses all uses of technology geared to remotely deliver health information or education. Telemedicine is the use of medical information exchanged from one site to another via electronic communications regarding a patient's clinical health status.

Telemedicine is a tool that may be utilized to augment the practice of veterinary medicine. The AVMA is committed to ensuring access to the convenience and benefits afforded by telemedicine, while promoting the responsible provision of high quality veterinary medical care. Veterinary care, whether delivered through electronic or other means, should be provided with professionalism.

The AVMA encourages the development of smart-device applications, other platforms and technologies that appropriately help connect current or lapsed clients and patients with veterinarians. In addition, veterinarians may utilize emerging technologies to enhance their accessibility and client communications, and support exceptional patient care.

Given the current state of technological capabilities, available research, and the current state and federal regulatory landscape, the AVMA believes that veterinary telemedicine should only be conducted within an existing Veterinarian-Client-Patient Relationship (VCPR), with the exception for advice given in an emergency until that patient can be seen by a veterinarian.

Most states and the AVMA's Principles of Veterinary Medical Ethics require a VCPR for a veterinarian to diagnose, prescribe medication or otherwise treat an animal. Federal law also requires a VCPR for prescribing extra-label drugs for animals and issuing Veterinary Feed Directives.

Under the VCPR, a veterinarian assumes responsibility for making medical judgments and ensures that he or she has sufficient knowledge of the patient to initiate at least a general or preliminary diagnosis of the medical condition of the patient.

The VCPR ensures that a veterinarian is readily available for follow-up evaluation, or has arranged for veterinary emergency coverage and continuing care and treatment. The veterinarian is expected to provide oversight of treatment, compliance and outcome, as well as document the patient’s continuing care and treatment in the medical record. The animal owner’s consent for the use of telemedicine must also be obtained and documented.

Without a VCPR, any advice provided through electronic means should be general and not specific to a patient, diagnosis or treatment.

The AVMA recognizes that future policy in this area will be informed by evidence-based research on the impact of telemedicine on access to care and patient safety.

With the exception of emergency teletriage, including poison control services, the AVMA opposes remote consulting, including telemedicine, offered directly to the public when the intent is to diagnose and/or treat a patient in the absence of a VCPR.

A veterinarian with a VCPR has the professional discretion to consult with specialists or other consultants. The specialist or consultant should not be required to hold an active veterinary medical license in the state within which the veterinarian with the VCPR practices or within which the patient or client resides.

Telemedicine regulations should be harmonized across the nation and strongly enforced to protect patient and public safety. The AVMA supports appropriate regulatory efforts to clarify where the actual practice of veterinary medicine occurs in telemedicine, who has regulatory enforcement and disciplinary authority, and which remedies are available in cases of patient harm.

Eligibility to provide veterinary medical advice by telemedicine should be limited to those who are also legally authorized to practice veterinary medicine in that state. Furthermore, credentials of all advice givers, as well as disclaimers on telehealth and telemedicine resources, should be unambiguous and prominently displayed. Veterinarians providing telemedicine services must ensure that clients are aware of the provider’s identity, location, licensure status, and privacy and security issues involved in accessing veterinary services through telemedicine.

Legal accountability, liability and responsibility of practicing veterinary medicine should be in both the state in which the patient is located and the state in which the veterinarian providing the service is located.