The American Association of Veterinary State Boards this year released a model telehealth policy for public review and comment. The policy includes a provision allowing for the possibility of establishing a veterinary-client-patient relationship (VCPR) without the necessity of a hands-on examination. Here is the specific language:
“A veterinarian using telehealth must take appropriate steps to obtain informed consent, establish the VCPR and conduct all appropriate evaluations and history of the patient consistent with traditional standards of care for the particular patient presentation. As such, some situations and patient presentations are appropriate for the utilization of telehealth as a component of, or in lieu of, hands-on medical care, while others are not [emphasis added].
The Potential of Virtual Care
Though the establishment of a telehealth policy would be precedent setting in the United States, the Canadian province of Ontario already allows for the creation of a VCPR through electronic means. What is important to note is that Ontario emphasized the importance of all the other acts normally expected of a veterinarian when establishing the VCPR, such as diagnosing and prescribing only when sufficient information is present and ensuring that the client knows about the profession’s standards.
In short, the same standards must be employed in Ontario. The only difference is the means by which the information is conveyed. The information is acquired electronically rather than in person. Should sufficient information not be available electronically, then an in-person exam might be necessary. Should that not be sufficient, then the veterinarian might have to perform further diagnostics.
Telehealth tools, also called virtual care or digital care tools, do not replace the in-person examination but rather expand the services offered by the veterinary team. The implications of offering more virtual care options have only begun to be explored. Though the emphasis has mostly been on what this trend means for veterinarians, more needs to be said about the implications for other members of the veterinary team.
Enter Veterinary Technicians
We know that credentialed veterinary technicians and nurses bring tremendous value to the team through their ability to work with practitioners by physically administering treatments and assessing patient progress. Millions of animals could be seen and standards of care maintained if properly trained and credentialed veterinary technicians were able to utilize virtual care technologies.
Granted, some animal health issues cannot be resolved by digital communication alone. They might require hands-on treatment, but those hands don’t necessarily have to be a veterinarian’s. Routine procedures like anal gland expression, administering subcutaneous fluids or medications, or monitoring parameters such as blood pressure can be done by an appropriately trained veterinary technician. Yet, the practice acts in some states do not permit veterinary technicians to perform these procedures in the animal’s home if a veterinarian is not supervising.
Should regulations be changed to allow veterinary technicians to practice a range of services so long as the veterinarian is consulted through electronic means, then we can see that pets now going without health care will be in a better position because of the reduced cost associated with a veterinary technician.
For example, think about geriatric or fractious cats. These animals often lack access to veterinary care because of the difficulty in bringing them to the clinic and the costs associated with their routine care. If a nurse could travel to the pet’s home and provide care, then those barriers to care would be immediately reduced.
An Extension of the Veterinarian
The argument against virtual care in veterinary medicine often boils down to the question of whether the VCPR can be established through virtual care tools in the absence of a physical examination. It might be true that virtual care tools provide only part of what an in-person physical exam can provide, such as visual and auditory clues and subjective input from the owner. But a credentialed veterinary technician has the education necessary to fill the gap by serving as the hands, eyes, ears and nose of the veterinarian while communicating her findings to the veterinarian for a diagnosis.
Such an arrangement is possible for patients residing in states in which the practice act allows for credentialed veterinary technicians to provide follow-up care when a relationship has already been established. In fact, nurses in human medicine are heavily utilized in follow-up home care while they maintain remote access to doctors.
The difference between having credentialed veterinary technicians or a noncredentialed person like a pet sitter perform the role is the educational standard. This is the point in which the problematic nature of veterinary technician and nurse credentialing lies. Eleven states do not license veterinary technicians, and many more do not restrict use of the title to licensees. Even in states whose laws dictate use of the title only by licensees, the laws can be loosely applied.
A Push for Standards
The Veterinary Nurse Initiative, launched by the National Association of Veterinary Technicians in America, aims to set credentialing standards throughout the nation. Anyone using the title “registered veterinary nurse” — RVN would replace current technician credentials — would have met education and training requirements, elevating the baseline competency level of these individuals.
This is not to mistake, however, the value of today’s credentialed veterinary technicians. The fact is that not every “veterinary technician” is created equal. The veterinary profession needs to work toward across-the-board standardization.
As virtual care expands and pet owners look for more accessible veterinary care, the establishment of nationally consistent standards and integration of the role of RVNs is vital so that pet owner needs are met. Efforts such as AAVSB’s telemedicine guidelines and NAVTA’s Veterinary Nurse Initiative will expand on the ability of veterinary teams to provide necessary care to a growing pet owner population.