Jessica Vogelsang, DVM, CVJ, is an author, veterinarian and educator from San Diego, California. She is the Chief Medical Officer of the American Animal Hospital Association. Dr. Vogelsang’s veterinary medical experience spans more than a decade in both general and emergency practice. She is the founder of the Facebook group Veterinary Telemedicine Community and also created the award-winning website pawcurious.com. She frequently writes and lectures on communication, end-of-life care, and emerging trends in the field, and she is the author of the bestselling memoir “All Dogs Go to Kevin.” Dr. Vogelsang earned her DVM at UC Davis School of Veterinary Medicine. She is a certified veterinary journalist.Read Articles Written by Jessica Vogelsang
At the start of 2020, assessing a pet’s hot spot or lameness over a video chat would have seemed absurd to most practitioners. That changed in a heartbeat when COVID-19 swept the globe, sending millions into quarantine and upending everything we thought we knew about the standard of care. Overnight, veterinarians’ views on telemedicine changed from skeptical doubt to panicked fear of missing out. Everybody assumed they would have years to figure out how to work telemedicine into their practices, but then the timeline changed to weeks.
Adjusting to an entirely new element of patient care such as telemedicine can feel like drinking from a fire hose. What’s worse, instead of finding a clear path to implementation, practices usually wind up bombarded with solicitations from a dizzying array of telemedicine platforms, each offering different perks and drawbacks.
After watching thousands of colleagues wade across the river one by one over the past weeks and months, I had one constant thought: Keep moving forward. The paths to the opposite shore are infinite, but all will get you there. First, understand what you’re providing and why. Then, ask yourself how you want to get there.
Here are four main things to keep in mind:
1. Telemedicine isn’t new. It’s as old as the telephone.
A veterinarian needs to understand the difference between implementing telemedicine and implementing a new telemedicine platform. Telemedicine is a service you likely have engaged in for some time, whether or not you realize it. Any time you utilize remote communication — by phone, email, photos or video — to give specific advice or to prescribe or diagnose, you’re engaging in telemedicine. The platform is simply the technology you choose to make the process more convenient.
Today, thousands of practice owners and managers are rushing to decide between provider A, B or C because they think a new platform is necessary when providing telemedicine to their clients. It’s not. Newer tools make gathering the information you need to help the patient a lot easier, but telemedicine also can happen with a phone and a pen. Understanding how telemedicine as a service integrates into your practice matters more than the technology you choose.
Another key to success is understanding that while telemedicine is limited to services allowed under the scope of the veterinarian-client-patient relationship, practitioners provide a great deal of value outside the VCPR in the form of advice, triage and consulting. Telemedicine platforms help you monetize the time you spend on those services.
2. Understand what you want your technology to do.
Ask yourself these questions before you even consider taking on a new platform:
- Do I have a list of use cases pre-approved for telemedicine, or will my staff decide case by case what to schedule? Am I limiting telemedicine to recheck exams or are we including new problems?
- How are we charging for teleconsults as compared to an in-house exam? If a patient needs to come in for further diagnostics, how will we charge for it?
- Will my clients accept the idea of teleconsults? How comfortable will they be downloading an app and setting up a video visit?
- Where do I draw the line between free advice and “This is an official consult”?
- How will I market the service so that clients are eager to utilize it?
Next, ask yourself why you provide telemedicine in the first place. Because it’s a new revenue stream? Or because you are honoring the law and protecting the safety of clients and employees during a pandemic? Once you know what you’re providing and why, only then should you move on to the question of how you will provide telemedicine.
3. Decide if you want an all-in-one solution or a do-it-yourself approach.
In order to provide telemedicine to your clients, you’ll need four things:
- A way to schedule appointments.
- A way to collect payment.
- A way to conduct the visit.
- A way to document the visit.
What you choose to do depends on your top priority at the moment. Let’s examine the two types of telemedicine platforms.
If cost is your priority, a do-it-yourself approach is the way to go. At its most cost-efficient, clinics can schedule telemedicine appointments the same way they do regular appointments: over the phone. Other calendaring options include Google Calendar and Calendly.
Clinicians can conduct the appointment using existing technology, such as a phone, or they can use a free or low-cost conferencing option such as Zoom, Google Hangouts or Skype. The visit can be manually documented in the records or uploaded as a transcription, recording or PDF. Payment is collected over the phone by charging a credit card on file or by invoicing through PayPal or Stripe.
While do-it-yourself is the least expensive option to implement, jumping between different platforms and figuring out how to put the workflow together can be time-consuming. In addition, these low-cost solutions rarely integrate with one another, necessitating extra steps in moving data from one part of the visit to the next.
If you have an app that includes messaging, many clinicians find that chats are an effective compromise between managing everything by phone and going to a full-service live video platform. Asynchronous communication allows for clients to send pictures or videos as well as text without requiring both doctor and patient to be online at the same time.
Many practitioners still wrapping their heads around the idea of using telemedicine are choosing the do-it-yourself approach to start, and then moving on to one of the more comprehensive solutions. For people on the fence about whether telemedicine will be a long-term presence in their practices, this is a solid, low-risk way to test the waters.
Even before COVID-19, the number of companies offering telemedicine technology solutions to veterinarians was growing by the month. Now, it seems to be growing by the week. With the explosion in demand, new companies are popping up left and right while established companies add new features in response to feedback. Expect a number of leaders to work their way to the front over the coming months, but for now it’s the wild, Wild West.
All-in-one solutions are preferred by those looking for convenience and time savings. While the initial onboarding requires investments of time and money, practitioners who do large numbers of telemedicine visits find that an integrated solution makes life a lot easier in the long run.
A typical app allows clients to schedule a consultation, enter a credit card, conduct the visit and access the documentation. The visit can be recorded or transcribed, and it is either uploaded to the patient record manually or directly through PIMS integration.
Here are questions you might want to ask when considering a telehealth platform:
- Does it require clients to download an app, or can they access the visit through a website?
- What is the cost to get the service up and running? Is a long-term commitment required?
- Does the platform provider charge a flat monthly fee or take a percentage of each visit?
- How is data stored, and how does the company ensure privacy and security?
- How long has the provider been in business? How many clinics use the platform?
- What, if any, PIMS integrations are offered?
- How are visits recorded and documented?
- Do clients pay before or after the appointment? Can you set the fee?
- How many doctors at your practice can access the service? Can multiple doctors do consults at the same time?
4. Let everyone know you’re offering the service.
Congratulations! You’re set up and ready to offer telemedicine. You wait a day or two, and then crickets. No one’s biting. Now what?
Clinics that successfully integrate telemedicine into their suite of services have one common denominator: a solid marketing strategy. In order to get an enthusiastic response, clinics need to effectively communicate how telemedicine can help solve the problem that clients are experiencing. During a pandemic, the problem is blindingly simple: They’re not supposed to leave the house.
Tip One: Don’t ask clients if they “want telemedicine.” To many people, that sounds like a hassle or a burden. Use verbiage that communicates the benefits of a virtual visit.
- “We can schedule this appointment as a virtual visit and perform the recheck without you needing to come in. Would you like to do that?”
- “We’re committed to keeping both you and your pet healthy during this time of physical distancing. That’s why we’re now offering virtual visits. Our team can help with many minor ailments and follow-up visits from the comfort of your living room. Call us to see how we can help.”
Tip Two: Be explicit in your client communication before a visit. When clients schedule a teleconsult for the first time, make sure they are set up for success.
In addition to explaining how a visit will take place, send an email that outlines the steps a client should take, such as:
- Download the app. (Remember to provide a link.)
- Upload photos or videos of the pet’s medical problem ahead of time so that the doctor can see them before the appointment starts. Photos of skin lesions and videos of lameness are two conditions that are especially helpful, according to doctors who conduct telemedicine consults.
- Secure the pet in the room with the client before the appointment begins.
Also explain to the client:
- The appointment will last “X” minutes.
- If the pet requires a prescription, one will be shipped or arranged for pickup.
- “If the pet requires additional care, we will ….”
Bringing clinics up to speed on telemedicine is a challenging but in no way insurmountable feat. There’s never been a time more amenable than now to take a chance, try something new and change the course of veterinary medicine. There’s no reason anyone needs to be left behind.