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Virtual care is the reality

General practitioners, specialists and even students have a role to play in the evolution of telehealth and the elimination of barriers to veterinary services.

Virtual care is the reality
The entire veterinary team and clients should be taught to utilize virtual care, know what can be handled appropriately through telehealth and understand what will require a visit to a brick-and-mortar veterinary clinic.
Lots of stuff is going on in the world of virtual care as its utilization shifts from innovators to early adopters and becomes more mainstream. Recent articles have shown increased client demand for telehealth services and satisfaction with its use. This past spring, the American Veterinary Medical Association hosted the Veterinary Virtual Care Summit, which brought together dozens of practitioners, leaders in the profession and providers of virtual care platforms. Many practitioners have found ways to incorporate virtual care into certain niches, such as behavioral consults, hospice and palliative care, triage, feline care and more. Others are using it for postoperative, dermatologic or ophthalmologic recheck visits. Some practices see growth potential for after-hours care — determining whether a patient needs to be seen as an emergency or if the problem can be handled during daytime hours. Some of the benefits are improved access to primary and specialty care, decreased stress for pet owners and patients, and opportunities for veterinarians to work from home when on parental leave or while recovering from an illness.

Keeping It Personal

What has also become readily apparent is that clients would prefer to receive virtual care services from their own veterinarian. Practitioners are considering ways to incorporate these visits into their daily workflow. As competition increases across the veterinary profession, virtual care visits are another way to reinforce the bond and trust between a veterinarian and client. For the health and well-being of practitioners, clients need to understand that their veterinarian is not accessible 24/7. Using a telehealth platform can help to better define these boundaries. Veterinarians can make themselves available on a virtual care platform or create a schedule for virtual appointments. Clients can be diverted from messaging the veterinarian via text or social media and instead engage in a virtual visit. If the veterinarian is not available, some platforms can further arrange for an urgent-visit request to be diverted to another colleague within the platform who might be able to provide general advice, though not make a diagnosis or prescribe a treatment plan. Non-urgent requests can be handled when the veterinarian is available. A bonus is that by utilizing a platform, the veterinarian can get paid for the virtual visit. It is important that veterinarians educate their team and clients about the transition to virtual care. Just as when a practice offers any new service or product, everyone must learn how it works, how to use it and how to best explain it to clients.

On-Demand Access

Virtual care can be a tremendous aid for anyone having difficulty accessing veterinary care. People can be underserved, not only for financial reasons but also because of their geographic location, weather issues, cultural or language barriers, transportation problems, or physical disability. Telehealth visits with a veterinarian can resolve some of the patient’s needs and reassure the client that if the patient needs a hands-on exam, making arrangements to overcome any barriers is worth the effort. Some telemedicine platforms provide language translation services as well. Access to care is an issue not only for clients but also for veterinarians, particularly solo practitioners or those who do not have ready access to specialists for referrals. And sometimes, veterinarians who have geographic access to specialists still find themselves with clients who decline a referral. Veterinarians regularly utilize radiology consults. The area of teleconsultation is rapidly expanding to cover other areas, including dentistry, ultrasonography, cardiology and more. Teleconsultations have been shown to provide support and reassurance to solo practitioners or recent graduates who might be dealing with complicated cases or unsure how to proceed with an issue. Having that reassurance and gaining support in how to handle a difficult case can do much to improve professional well-being and confidence.

VCPR Requirements

The veterinarian-client-patient relationship (VCPR) is still a concern for many involved with virtual care. It is an area where veterinarians want to tread carefully to make sure they are doing the best they can for an animal’s health while balancing the client’s needs. A year ago, the American Association of Veterinary State Boards revised its Practice Act Model to allow for veterinarians to use their own judgment in determining when they can help using a virtual visit versus when a hands-on exam is necessary. Any patient visit should meet the standard of care, whether done in a brick-and-mortar clinic or via telemedicine. At certain times, a patient can be helped only when the veterinarian puts hands on the animal or does diagnostic or therapeutic procedures available only in a veterinary hospital. AVMA policy states that the veterinarian-client-patient relationship must be established through an in-person visit. After that, a veterinarian is free to use whatever modality he or she deems appropriate to help a patient, within the boundaries of state and federal law. As technology advances and needs change, the AVMA remains open to revising its policies to best serve the profession and its members. Technology advances and the shortage of veterinarians in certain specialties or regions might put pressure on legislators and regulators to modify the VCPR. A couple of examples would be a referral to a veterinary behaviorist or nutritionist. The veterinarian in general practice can do the physical exam and any necessary diagnostic testing, and then the veterinary behaviorist could have virtual visits with the client and patient to outline a treatment plan. Similarly, the primary care veterinarian can do an exam, work-up and diagnostics and then refer the client to a veterinary nutritionist who can customize an appropriate diet. The virtual visit would be between the behaviorist or nutritionist after the referral by the veterinarian overseeing the case. Communication between all the parties is key, but sometimes it can be more effective without the primary care veterinarian being in the middle, as long as the practitioner remains looped into the communications regarding the devised treatment plan and necessary follow-up care.

What Texas A&M Is Doing

The Texas A&M University College of Veterinary Medicine and Biomedical Sciences is rolling out a virtual care program to support veterinarians, especially those in rural or underserved communities. Veterinarians in private practice will be able to schedule virtual consults with a specialist. The platform allows the specialist to upload images, laboratory results and other pertinent information before the scheduled consultation. The client could be virtually looped in as well, if needed. Video outputs will allow for remotely guided ultrasonography, dentistry and more to be handled during these consultations. A written report will be sent to the general practitioner at the conclusion of the virtual consult. Veterinary students might be able to participate in the consults, exposing them to the problems that veterinarians in general practice regularly handle, and thus enhancing their education and better preparing them for life in practice. In addition, the general practitioner will be able to receive continuing education credit for the virtual visit. The second phase of Texas A&M’s telehealth program will involve offering virtual visits directly to established clients and patients. This will improve access and decrease travel time for clients who have difficulty with long drives for follow-up care.

Last Thoughts

Finally, wearable devices are becoming much more prevalent among companion animals. Food animal operators are long familiar with this technology. As more clients adopt such devices, remotely monitoring chronic conditions and the health status of patients or patient populations will become easier. Shelters that cannot afford a full-time veterinarian could utilize virtual care platforms to help manage their populations, especially to guide protocols established by a veterinarian and to manage disease outbreaks. The military uses these applications to help care for working dogs in combat zones, and disaster response and rescue teams are adopting these technologies to better manage their dogs’ health and welfare. The veterinary profession needs to continue to work through legislative and regulatory issues as they arise. Understanding liability concerns and maintaining standards of care are key to successfully utilizing virtual care. Communication between all parties is an absolute must. The entire veterinary team and clients should be taught to utilize virtual care, know what can be handled appropriately through telehealth and understand what will require a visit to a brick-and-mortar veterinary clinic. Like most things in veterinary medicine, there is no one-size-fits-all approach. Virtual care is no different. We can use it and use it wisely. Innovation Station guest columnist Dr. Lori Teller is a clinical associate professor of telehealth at the Texas A&M University College of Veterinary Medicine and Biomedical Sciences. She is the District 8 representative on the American Veterinary Medical Association board of directors.