Exploring the legal landscape of virtual care
A VCPR cannot be established solely through telemedicine.
–FDA letter to AVMA
Having a Veterinarian-Client-Patient Relationship in place is critical whenever practicing veterinary medicine, whether you are practicing in person or remotely through telemedicine. The AVMA Model Veterinary Practice Act, which many governmental bodies use as a guide when establishing or revising laws governing veterinary practice, includes the following definition of the VCPR:
A VCPR is present when all of the following requirements are met:
- The veterinarian has assumed responsibility for making clinical judgments regarding the health of the patient, and the client has agreed to follow the veterinarians' instructions.
- The veterinarian has sufficient knowledge of the patient to initiate at least a general or preliminary diagnosis of the patient’s medical condition. This means the veterinarian is personally acquainted with the keeping and care of the patient by virtue of a timely examination of the patient by the veterinarian, or medically appropriate and timely visits by the veterinarian to the operation where the patient is managed.
- The veterinarian is readily available for follow-up evaluation or has arranged for the following: veterinary emergency coverage, and continuing care and treatment.
- The veterinarian provides oversight of treatment, compliance and outcome.
- Patient records are maintained.
Many states have adopted this definition of the VCPR, or a very similar one, as a component of their state veterinary practice act. In addition, federal law requires a VCPR for extralabel drug use in animals, issuing a Veterinary Feed Directive, and the creation and use of certain types of biologics.
Given current technological capabilities, available research, and the existing state and federal regulatory landscape, veterinary telemedicine should only be conducted within an existing VCPR. An exception may be made for advice given in an emergency situation until a patient can be seen by a veterinarian. How a state defines the VCPR, the congruence of that state VCPR with the federal VCPR, and whether or not a VCPR exists in a given situation based on those definitions, must be guiding principles in deciding what services can be offered.
A Veterinarian-Client-Patient Relationship cannot be established solely by telephonic or other electronic means.
–AVMA Model Veterinary Practice Act
Within an established VCPR – A variety of telehealth and telemedicine service models are available to veterinarians and veterinary hospitals. Client-facing telemedicine services may include use of tools that allow the veterinarian to remotely gather all essential veterinary medical information from the animal owner or other caretaker; access the patient's medical records; and conduct a virtual exam of the patient through real-time video or by attached pictures.
Without an established VCPR – The veterinarian may provide general advice but must specifically stay clear of diagnosing, prognosing, or treating patients. Advice should not be specific to an individual animal, diagnosis or treatment. Non-client electronic communications should be in the non-clinical realms of general advice, mHealth, web content, and other generalized messaging.
Licensure considerations in telemedicine
Treating patients across state lines
One of the many benefits of telemedicine is that it collapses distances and makes it easier for veterinarians to work with patients and clients who are physically remote from the clinic. When conducting telemedicine consults across state lines, it’s advisable for the veterinarian to be licensed both in the state where (s)he is located and the state where the patient is located. The importance of this can’t be overstated. Should issues arise, being licensed in both states ensures the veterinarian is legally authorized to practice. Just like a valid VCPR, established through a physical examination, licensure in both states protects both veterinarians and our patients.
Consulting with specialists
A veterinarian working within a VCPR may use his/her professional discretion to consult with specialists or other consultants. In such cases, the veterinarian who is asking for the specialty advice must have a VCPR in place, as well as the necessary license(s) to practice. The AVMA believes that the consulting specialist should not need to meet these same requirements, as long as (s)he is working through the original veterinarian. If the consultant were to begin treating the patient independently of the first veterinarian, then the consultant would need to establish a separate VCPR and be licensed within the patient's state.