Telemedicine is a hot topic right now and has generated a lot of controversy over whether it should be part of how veterinary medicine is practiced. Some of this controversy is due to confusion over what all the “tele-terms” really mean; however, some of the controversy is also over real issues related to whether pets can be appropriately diagnosed and treated using some of these modalities.
Telehealth, the umbrella term, is defined as follows: “all uses of technology to deliver health information, education, or care remotely.” Telehealth can include both services that require a VCPR (veterinary-client-patient relationship) and those that don’t. The definitions of the telehealth services shown below are based on the 2018 AVMA-AAHA document entitled “The Real-Life Rewards of Virtual Care.”
- Telemedicine: the practice of veterinary medicine using technology as a communication tool (requires a VCPR)
Teleconsulting—the use of telehealth tools by a general practice veterinarian to communicate with a veterinary specialist about the care of a patient
- Telemonitoring: the remote monitoring of patients who are not at the same location as the healthcare provider
- Teletriage: safe, appropriate and timely assessment and management of animal patients via electronic communication with their owners under conditions of uncertainty and urgency and where a diagnosis is not rendered
- Electronic prescribing: the digital-based electronic generation, transmission, and filling of a medical prescription
- Teleadvice: providing health information that does not require a VCPR to pet owners or other parties using technology
To find out where practices stand on telehealth, VHMA asked managers as part of their April 2019 Insiders’ Insight Management Survey to identify their current and future practices.
When asked “What types of telehealth services does your practice currently provide? (Electronic communication can be via the telephone, email, fax, text, video conferencing, mobile app, web-based chats, wearable monitoring devices, etc.).” Not surprisingly, the most used services are teleconsulting with specialists and electronic prescribing. Telemonitoring is not used extensively at this time, and only about 1/3 of practices are providing true telemedicine services which require a VCPR.
When asked “What technologies does your practice use in telehealth communication?”Telephone, email and messaging lead the pack, but it is worth noting that 100% of practices didn’t select the phone as an option. That indicates some practices are very strict about the kind of information they will discuss even when a VCPR isn’t required.
A big question that comes up when discussing telehealth is can these services be charged for and how to do it? The VHMA survey asked, “Does your practice charge for the following types of telehealth services?”
Answers are all over the board, but in summary, most practices are not offering many of these telehealth services and, of those that do, few are charging for all or most of the services provided.
When asked if practices have discussed telemedicine as a business strategy, not quite 40% of the practices surveyed have discussed telemedicine as a business strategy; the majority of practices have not. However, the majority of practices have indicated they are at least thinking about telemedicine as a potential service to be offered or expanded in their hospital.
The next question asked: “In what ways is your practice thinking about expanding your telemedicine services?” Telemonitoring via pet wearable devices generated the least interest while almost 50% of the respondents indicated interest in live virtual appointments and asynchronous electronic consultations. 2/3 of the “other” comments stated their practice was not looking at using any of these options. Several others said their practices are considering telemedicine and exploring options but not yet sure how it can best be utilized.
Most managers think their team members have concerns about the legal liabilities of telemedicine. They also think their clients would appreciate the additional access to the professional staff.
Telehealth and telemedicine are in their early days in veterinary medicine, and very few practices are comfortable jumping into all aspects of it. There is a lot to be worked out. Telemedicine is becoming increasingly popular in human medicine, and it is likely the veterinary profession will feel ongoing pressure to participate. Ignoring the issue or just saying no won’t make it go away. Veterinary professionals need to shape telemedicine and telehealth in a way that works for the business side of the practice and provides quality care to our patients (does not harm).
Read the full report - VHMA Insiders' Insight April 2019
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