AVMA panel to scrutinize telemedicine

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The controversial topic of telemedicine in the veterinary profession was brought into the national spotlight in early 2015, when a Texas veterinarian was disciplined for violating the state practice act and subsequently filed a lawsuit against the state board. The U.S. Court of Appeals for the Fifth Circuit found that Dr. Ronald S. Hines’ rights were not violated by the Texas state board’s requirement that a physical examination of the animal or premises must occur for a valid veterinarian-client-patient relationship to exist. Dr. Hines had been giving veterinary advice to pet owners by phone and email as far back as 2002.

The practice of telemedicine remains an unresolved issue in veterinary medicine. In fact, the practice of exchanging medical information via electronic communications to improve patients’ health status will only become more prevalent, according to Dr. Mark P. Helfat, AVMA Board of Directors vice chair and District II representative. He pointed to apps that are entering the market such as Vet On Demand and PetCoach, the latter of which offers “direct advice from verified vets, trainers and other pet experts.”

Dr. Helfat spoke about telemedicine during the Sept. 10-12 AVMA Board meeting at AVMA headquarters in Schaumburg, Illinois. The Board ultimately recommended that telemedicine be among the topics covered by the new AVMA Practice Advisory Panel.

It is one of two panels—the other is the Regulatory Advisory Panel—that are part of a pilot program designed to address difficulties in filling vacancies on councils and committees, prevent overlap or confusion of purpose among councils and committees, and cut down the amount of time it takes to develop policy.

“It’s an experiment for a potentially better way to do our governance,” said Dr. Helfat, who is the Board liaison to the panels along with Dr. Lori Teller, District VIII representative on the Board.

Dr. Gary Brown, AVMA Board of Directors District V representative, at the most recent Board meeting, held Sept. 10-12 in Schaumburg, Illinois (Photo by R. Scott Nolen)

The advisory panels are charged with protecting, promoting, and advancing the veterinary profession by strategically identifying, prioritizing, and processing important veterinary issues and making recommendations to the Board. The Practice Advisory Panel will focus on clinical practice and small business issues, while the Regulatory Advisory Panel will focus on veterinary regulatory–oriented matters that are germane to the panel’s delineated areas of expertise. Panel members have been selected to achieve a balanced range of experience in subject matter and with diverse animal species. Both panels have the authority to convene working groups.

The panels’ first meetings took place Oct. 2-3.

As part of the panel’s evaluation of telemedicine, the Board asked that members include input from the AVMA Group Health & Life Insurance Trust and AVMA PLIT as well as the AVMA House of Delegates. The hope is for the panel to have recommendations for the Board to consider in the near future.

“It is important to get out in front of this and have the panel make recommendations. I think there’s a lot of parties at the AVMA involved in this topic, such as the Judicial Council and Legislative Advisory Committee, as well as the (American Association of Veterinary State Boards) and (Association of American Veterinary Medical Colleges),” Dr. Helfat said, adding that the Board and House could work together to adopt an official policy.

The AVMA doesn’t have an official stance on telemedicine, but included in the AVMA Model Veterinary Practice Act is this sentence in the section outlining the veterinarian-client-patient relationship: “A veterinarian-client-patient relationship cannot be established solely by telephonic or other electronic means.”

Another model practice act, this one from the AAVSB, reads: “It shall be unlawful for any Person who is not licensed in this state to provide veterinary medical services from any state to a Client or patient in this state through telephonic, electronic or other means.” It goes on to say, “With the advent of technological advancements leading to increased mobility of Veterinarians, Veterinary Technicians and practice itself, it may be prudent to anticipate and address practice by Persons not physically located within the state. Rather than attempting to define ‘telepractice’ or create a limited license to address sporadic practice, it is recommended that legislatures address these technologically driven practice issues through a temporary practice approach. This temporary practice language is intended to address sporadic practice within the state irrespective of whether it is electronically rendered or rendered in Person.”

Some of the first states to adopt laws pertaining to veterinary telemedicine were Oklahoma in 1999 and Idaho in 2001. They included telemedicine in their definition of the practice of veterinary medicine. Iowa, Mississippi, Tennessee, Texas, and Utah have provisions that specify that a VCPR cannot be established solely through telephonic or electronic means. Colorado adopted language restricting telephone or electronic means in its definition of “indirect supervision” of nonveterinarians. Other states have VCPR provisions without specific mention of telephone or electronic communications, while a handful of states have not formally adopted VCPR language in their practice acts or regulations.

Clarification: The article should have included Illinois as a state that prohibits establishment of a veterinarian-client-patient relationship solely through electronic or telephonic means.