Most of us within the veterinary profession agree that individual practitioner wellbeing and student debt are two of the most important issues facing our profession.
Another topic that is receiving a great deal of attention is veterinary telehealth (see definitions below). At their first Board Meeting in January, 2016, the Veterinary Innovation Council (VIC), an industry-wide group lead by the NAVC, committed to tackling the largest challenges and opportunities facing the profession.
Specifically, they chose telehealth as their inaugural focus. Since then the VIC telehealth project launched telehealth-related pilots in Texas and is currently expanding into additional states this year – all with the goal of creating telehealth success models and best practices to share with the profession.
Telehealth – the overarching term that encompasses all uses of technology geared to remotely deliver health information, education, or care.
Telemedicine – a subcategory of telehealth that is a tool, or use of a tool, to augment the practice of veterinary medicine. An example would be using skype or a specialized app to communicate with a client and visualize the patient for a postoperative follow-up examination and discussion.
Teleconsulting – a subcategory of telehealth that occurs when a general practice veterinarian utilizes telehealth tools to communicate with a veterinary specialist with the goal of gaining insights and advice regarding the care of a specific patient.
The AVMA released a 45 page Telemedicine Report in early 2017 which includes a comprehensive telemed/telehealth overview and the recommendation to stay the course with existing healthcare models while continuing to explore the telehealth landscape.
Telehealth related sessions have been a part of nearly every veterinary-related event so far this year including the AVMA Veterinary Leadership Conference, the NAVC Conference, Western Veterinary Conference, VetPartners Annual Meeting (Fig 1), and VMAE ThinkWorks (Figs 2 & 3).
Telehealth in many ways is already here and has been around for a long time. Think Cardio Pet and texting answers to family members and friends (and in some practices – their clients) about their pets. In fact just this morning I had a fellow gym goer from Greensboro, NC send me a Facebook message with a question about her dog’s dewclaws. Instead of being viewed as a negative disruptive change, telehealth can be viewed for what it really is – another step in our continual evolution to raise the bar of healthcare quality standards.
As technology rapidly expands, there will continue to be more ways to connect remotely with patients and clients. Because of this, our current healthcare models are ripe for revamping. Telehealth will allow connectivity to pet owners and pets that aren’t routinely receiving veterinary care and will deliver on their expectation of convenience. So again, what’s the fuss? There are differing views within our profession because while telehealth in it’s simplicity is an extension of existing veterinary care models, it’s also change – and thus brings new challenges and unanswered questions that deserve our attention.
Next to come will be the standardization of wearable technology and sensors so that veterinarians can incorporate data from multiple sources as part of their exam as they ascertain the state of health of their patient. Veterinarians will then use their professional discretion to decide what should happen next. Can diagnosis and treatment for a specific patient and issue at a specific point in time be made virtually? Does a veterinary technician (nurse!) need to be deployed to the client’s home and be with the client and patient on the receiving end of the telehealth visit? Does the client and patient need to come into the practice? All of these are options that veterinarians will have at their disposal.
The idea isn’t to replace live visits with virtual visits, but rather to supplement and extend veterinary care where appropriate so that more animals receive the highest quality care. Many within our profession are holding on tightly to the notion that the only way to establish a valid veterinary client patient relationship (VCPR) is with an in-person exam. Others, including the VIC Board of Directors, feel the decision to use (or not use) telehealth tools should lie with the attending veterinarian.
Telehealth is another tool in the veterinary toolkit that veterinarians should be able to use at their discretion. We need to work together to understand (and likely revamp or create new) regulations, legislation, and answers around liability and legal issues, informed consent, client/patient confidentiality, pricing models, and practice workflows. We also have much to learn from our human healthcare counterparts – they have embraced telehealth and it is becoming a normal part of their workflow with great success. As an example, last week UC Davis released an update on how their telemedicine services save time, money, and help improve air quality.
Great news! There are many reports and studies that support telemedicine use in human pediatrics – another cohort that relies on another to be their voice.
Something to think about out as we come to an end of this update: What if instead of recommending only annual or semi-annual visits we establish monthly virtual check-ins with each patient and client? In between these visit wearables on our patients are sending activity and health-related data into our veterinary practice 24/7. The monthly check-ins could be held virtually up to the point the veterinarian recommends in-person connectivity. Convenience and true patient-centered care are paramount – we all agree on that! We just need to better understand how we can use the tools available to us today (and those that are coming right around the corner) so we can put it all to good use.
By working together as a profession we can create solutions and best practices that bring us into the future of veterinary healthcare which emphasizes a personalized, customized, patient-centered approach.
For more information I encourage you to read the AVMA Telemedicine Report along with the VIC Board of Directors consensus response, and feel free to share your feedback. There will be a telemedicine session Sunday afternoon, July 23rd at the 2017 AVMA Convention and we are hosting a VIC Reception and Telehealth update at the convention on Sunday, July 23rd at 6 PM. I hope to see you there!
Mia Cary, DVM
NAVC Chief Innovation Officer
Veterinary Innovation Council Executive Director