Veterinarians encouraged to take telehealth for a spin

Telehealth and virtual care aren't a replacement but rather an extension of veterinary practice, said Dr. Michael Bailey, a veterinary radiologist and AVMA Board of Directors member.

Their use has been increasing in human emergency rooms, rural clinics, and even patients' homes, especially as patients prefer asking questions about routine care electronically over visiting a clinic, said AVMA Deputy CEO Adrian Hochstadt. These trends can also be seen in veterinary medicine but with one big caveat: Telemedicine should only be conducted within an existing veterinary-client-patient relationship, except for advice given in an emergency until a patient can be seen by a veterinarian, according to state and federal law.

Dr. Bailey said other key points to remember about telehealth are as follows:

• Without a VCPR, any advice provided through electronic means should be general and not specific to a patient, diagnosis, or treatment.
• Except for emergency teletriage, including poison control services, the AVMA opposes remote consulting offered directly to the public when the intent is to diagnose or treat in the absence of a VCPR.
• The veterinarian with the VCPR has professional discretion to confer with specialists or consultants.
• The telehealth provider must be legally authorized to practice veterinary medicine.
• The credentials of all advice givers, as well as service disclaimers, should be unambiguous and prominently displayed.
• Telemedicine should be done in the highest standard of care.

Dr. Bailey gave a talk during a session at AVMA Convention 2018, July 13-17 in Denver, titled "Take-Aways From The Trenches: Telehealth in Veterinary Medicine," along with Hochstadt, AVMA Chief Veterinary Officer Dr. Gail Golab, and Dr. Mia Cary, AVMA chief of professional development and strategic alliances. The speakers explored practical and regulatory topics such as ensuring patient safety, the role of the veterinary team, licensure, liability, and how to effectively build telehealth into a practice.

Dr. Bailey also advised that there are some concerns about potential monetary considerations. He recommends a fee-for-service structure.

"But before doing that, have a legal consultation so you're not violating laws in your state," he said.

As is, state laws are in flux, as efforts are being made to modify requirements for the VCPR to support telehealth.

In 2017, Virginia passed a law that allows a veterinarian who performs or has performed an appropriate examination of a patient to prescribe certain controlled substances to a patient via the practice of telemedicine.

Laws in Illinois, Iowa, Mississippi, Tennessee, Utah, and Washington say a VCPR cannot be established solely by telephone or other electronic means. Florida, Georgia, Oregon, and Utah have proposed legislation on this issue.

Hochstadt noted that regulatory barriers are coming down at the national level. For example, the Centers for Medicare and Medicaid Services announced July 12 a proposed rule that, if adopted in its current form, will add multiple procedures to the list of Medicare-covered telehealth services and will pay separately for two newly defined physicians' services furnished using communication technology.

Two days later, the Federal Communications Commission said it will seek to establish a new $100 million Connected Care Pilot Program to increase access to telehealth services for low-income Americans, especially those living in rural areas and veterans.

"We can see the trends coming our way as we see human medicine has gotten out ahead first," Hochstadt said. "Clients are getting more sophisticated. They expect on-demand experiences like they get with Netflix or Amazon. The delivery of veterinary care is being transformed before our very eyes."

Dr. Bridget Heilsberg, owner of Crown 3 Equine Veterinary Services in Whitesboro, Texas, and president of the Women's Veterinary Leadership Development Initiative, said her practice wouldn't be as efficient if she weren't able to use telehealth for follow-up appointments, wound care, and communicating with multiple stakeholders at once.

"Most racehorses are owned by five or six people at a time. Rather than calling them individually, I record a video of an exam and upload it so they can all access it. I also put it into medical record and patient file," she said.

To further encourage practitioners to explore the benefits of telehealth, the AVMA has created the Telehealth Resource Center.

The site launched earlier this year. It has descriptions of service models, equipment resources, a monetization guide, steps for how to build telehealth into a practice, and more. Additional case studies were posted recently that range from equine to bovine to poultry medicine and involve post-surgical rechecks, hospice care, case triage, and electronic monitoring of flocks. More information will continue to be added, including on how pet health insurance companies are handling this modality.

AVMA members who have questions on telehealth or suggestions on what to include as a resource on the site can email telehealthavma [dot] org (telehealth[at]avma[dot]org).

"We are all dabbling (in telehealth), whether it's phoning or texting clients," Dr. Cary said. "Explore. Test things out. Eventually, demand will be there from clients, if it's not already. Embrace, don't fear."

An upcoming webinar in the AVMA's Lead and Learn series is dealing with telehealth.

AVMA members can sign up to join the session "Virtual Care—The Why, What, and How" at noon CDT on Sept. 25.

The webinar will cover the basics of the virtual-care landscape and how to implement the services into practice.

Related JAVMA content:

Telehealth poses new possibilities, problems (March 1, 2018)

AVMA creates tools, resources on telehealth (March 1, 2018)

AVMA helping veterinarians take on telemedicine (Sept. 15, 2017)

Defining relationships (June 1, 2017)