Eleanor M. Green
DVM, DACVIM, DABVP
Dr. Eleanor M. Green is the former dean of veterinary medicine at Texas A&M University and is a senior adviser and consultant with Animal Policy Group. She is a founding board member and co-chair of the Veterinary Virtual Care Association and was a founding faculty member of the Mississippi State University College of Veterinary Medicine. Dr. Green served as president of three national organizations: the American Association of Equine Practitioners, the American Board of Veterinary Practitioners and the American Association of Veterinary Clinicians.Read Articles Written by Eleanor M. Green
Innovation Station guest columnist Ashby Green is the chief financial officer of Soma Global Inc. and the founder of Gazelle Capital. He has nearly 25 years of accounting, finance and leadership experience.Read Articles Written by Ashby Green
Innovation Station guest columnist Dave Summitt is the chief information security officer at Alpha Omega Advisors and the former CISO at H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida.Read Articles Written by Dave Summitt
Politics & Policy columnist Mark Cushing is a political strategist, lawyer, founding partner of the Animal Policy Group and founding member of the Veterinary Virtual Care Association. Since 2004, he has specialized in animal health, animal welfare, and veterinary educational issues and accreditation. He is the author of “Pet Nation: The Inside Story of How Companion Animals Are Transforming Our Homes, Culture and Economy.”Read Articles Written by Mark Cushing
Veterinary medicine has the distinct advantage of being able to observe trends, discoveries and new methods of health care delivery in human health care, and the reverse is also true. There are lessons to be learned from telemedicine in human health care, and veterinary medicine is uniquely positioned to benefit substantially from advances in human telemedicine, while avoiding re-creating the wheel.
This poses important questions. Are we, in veterinary medicine, taking full advantage of these opportunities? More importantly, are we leading?
Telemedicine in Human Medicine
Telemedicine has become standard medical practice and has reached the point that it is being integrated into human hospitals, emergency rooms, private physician practices, specialty practices, patient’s homes, rural areas, workplaces, schools and disaster response efforts. In addition, programs are being developed to utilize telemedicine to address rural health and underserved populations, resulting in coordinated patient care with an interprofessional approach. Not only do these programs reach more people needing care at a faster pace, but they increase physician utilization.
Telemedicine has transformed in-school care, allowing students, faculty and staff immediate access to needed medical care. This in-school care has been shown to increase attendance and decrease workday interruptions of working parents. The majority of employers are on board with the addition of telehealth services in their benefits packages.
Today, it is possible to provide integrated health care delivery across an entire health care system and between systems. With telemedicine, health care professionals can reach patients remotely to evaluate, diagnose and treat using telecommunication technology; conversely, patients can reach their health care providers remotely. It can increase patient access, expand the reach of health care and extend coverage around the clock.
Being substantially less expensive than office visits and urgent care, telemedicine saves time and money, while providing care to more people. Telemedicine transforms patient engagement. Patients have expressed high acceptance of and enthusiasm for telemedicine, with some surveys demonstrating 90 to 100 percent positive feedback from patients. Many patients have expressed their willingness to switch doctors to get video visits as part of their health care. There are benefits for providers as well. Physicians have stated that telemedicine saves time, creates more free time, improves their efficiency and even prevents physician burnout.
Licensing issues have deterred telemedicine over time. Questions raised have included the physician-patient relationship, remote versus in-person examinations, state licensure and prescribing medications.
Recent legislation made history as the 50th state passed legislation expanding the use of telemedicine in human health care. The May 16, 2017, headline in Health Care Law Today read, “‘Lone Star’ Joins the Rest of the Nation as Texas Passes New Telemedicine Law.” This bill allows Texas-licensed physicians, or health professionals acting under their supervision or delegation, to provide medical services by telemedicine at a different location than the health professional. It specifically allows physicians to use telemedicine to establish a valid physician-patient relationship without the requirement for an in-person examination. The physician may establish a physician-patient relationship and provide health care services by way of synchronous audiovisual interaction, asynchronous store and forward technology, and other telecommunication technologies that comply with the standard of care. The standard for a physician providing care by way of telemedicine should be and is the same as that for in-person care. Additionally, the new law prohibits a health plan from excluding care provided via telemedicine simply because it is not in-person care.
Participation in telemedicine was slow at first. There are many reasons for this delay in uptake. The desire to implement telemedicine practices precedes the ideal technologies, communication platforms, software, data access, apps, business models and other tools. There is a learning curve, a time commitment and competing priorities in changing from traditional office visits to telemedicine services. Many physicians may not fully understand the potential clinical uses of telemedicine and may not envision how telemedicine services would fit into their daily schedules. Patient acceptance is essential, and patients may not be aware of telemedicine options or of their advantages.
Telemedicine continues its upward growth; in fact, it has become a multibillion-dollar industry. The market value of telehealth is projected to reach more than $36 billion by 2020. With the majority of patients expressing interest in telehealth services, 83 percent of hospital executives plan to invest in telehealth systems and services to outpace competition and broaden market reach. The state of telemedicine today is positive, as demonstrated by physician involvement, growing patient interest, best practices, viable tools, increased acceptance within health plans and favorable legislation.
The future of telemedicine is bright. It will evolve, exponentially at times. There is a clear trend toward real-time monitoring, reporting and analyzing. Digital labor will enable real-time monitoring without human intervention, such as with robotics and cognitive computing. Connected clinics are expanding to connected systems. Twenty-four-hour care will be achievable with greater efficiency and effectiveness. Virtual practices will mirror brick-and-mortar practices. New online-only practices will increase in number and acceptance. Central to all efforts is personalized patient care with an experiential foundation.
Discussions and lively debates about veterinary telemedicine are being held with increasing frequency. Entire sections at veterinary continuing education meetings are devoted to telemedicine. The North American Veterinary Community’s Veterinary Innovation Council identified telemedicine as its first significant area to explore. The American Veterinary Medical Association charged its Practice Advisory Council with reviewing telemedicine and making recommendations, the result of which was the AVMA telemedicine report. The American Association of Veterinary State Boards is strongly considering veterinary telemedicine and the appropriate laws surrounding it.
The fact is, veterinary telemedicine is not new and its future is bright. Phone calls, email, text messaging, instant messaging, picture messaging, video messaging and live video conferencing all constitute telemedicine. Most veterinarians employ some of these tools. As in human medicine, telemedicine will expand as more digital tools are developed. Wearable devices and remote sensors will expand, and are already expanding, well beyond activity monitoring.
The current landscape of veterinary telemedicine indicates a gap between what veterinarians offer and what clients want. Veterinary business specialist Ed Blach, DVM, MBA, reports that:
- 40 percent of veterinarians do not answer client questions by phone. They instead ask clients to come in to the clinic.
- 70 percent of veterinarians believe that technologies can strengthen the veterinarian-client relationship.
- 70 percent of veterinarians are unlikely to offer any telehealth service in the near future.
- 85 percent of pet owners find that the connection to a veterinarian via telehealth is appealing.
If We Don’t Embrace Veterinary Telemedicine …
Animal owners still regard veterinarians as the animal health experts and the most trusted source for animal information. As they become increasingly aware of the benefits of telemedicine from their family physician, they likely will find it a necessity for their animal health care as well. They will become aware at a staggering rate. The 2017 KPMG Digital Health Pulse 2017/HIMSS Analytics study showed that 75 percent of medical practitioners are employing digital or telemedicine care services. This is greater than 100 percent growth since 2014, when the use rate was 33 percent.
Human patients have indicated that they will change physicians to get telemedicine videoconferencing. Arguably, the same will be true in veterinary medicine.
Telemedicine is nothing more than adapting to pet health care the digital tools we use everywhere. What are the consequences if veterinarians send the message to clients, from boomers to millennials, that the tools they use every day in their lives are not welcome in veterinary medicine? They are not going to choose between digital or not; they are going to choose between veterinarians who use digital and those who do not.
Thriving veterinary practices fundamentally understand the value of providing personalized customer service and offering what the client wants, not just what they want to offer. When Uber came into existence, the company thrived because it improved the customer experience substantially using the digital tools they preferred. The taxi industry responded by fighting and trying to eliminate Uber rather than adapting its model to improve the customers’ experience and meet their needs. Veterinary medicine should focus on the customer experience and expand animal health care through telemedicine.
A significant threat is the potential for nonveterinarians to offer telemedicine care services to fill the void created if veterinarians do not provide them. Complicating this threat is that no laws govern the veterinarian-client-patient relationship for nonveterinarians. This potential scenario is a major reason the veterinary profession must lead these efforts, not just follow and not just wait to see what happens.
The most frequently expressed concern about veterinary telemedicine is the VCPR and the reluctance to turn loose of the requirement for an in-clinic examination. Veterinary medicine should demand the use of telemedicine as it is used in human medicine. Not allowing veterinarians to use information received by way of electronic means, whether or not a VCPR had been established in person, inappropriately prohibits veterinarians from exercising their professional judgment. Current VCPR restrictions limit the veterinarian’s capacity to practice veterinary medicine and can limit the quality and quantity of care provided to patients.
Occasionally, opportunities come along that have potential for profound effect on individual veterinarians, their practices and the profession as a whole. Telemedicine is one of those exciting opportunities. Telemedicine can elevate the quality of patient care, reach more animals effectively and efficiently, and provide new business models and novel career paths.
Telemedicine is the natural evolution of health care in the digital world. Veterinarians who effectively integrate telemedicine into their practices will better serve their clients and patients.