In a profession that has been strained by the pandemic, compassion fatigue, burnout, and suicide, we, as veterinarians, need workable solutions. One invaluable option is the appropriate use of virtual veterinary care.
Telemedicine, teletriage, and other virtual care modalities offer many benefits for those working in the veterinary community, as well as clients and pets. These services provide increased access to care for patients while simultaneously supporting pet owners in distress and alleviating excess workload for veterinary clinical staff. Indeed, according to the Canadian Veterinary Journal, the “…ramifications for practitioners of increasing delivery of veterinary telemedicine services…include meeting increasing client demands, less fatigue/greater efficiency, more revenue, better client retention, happier associate veterinarians, and a novel way of delivering veterinary service.”1
What is veterinary telemedicine?
The College of Veterinarians of Ontario (CVO) defines telemedicine as:
“…the provision of specific veterinary medical advice and veterinary treatment of an animal(s) or group of animals based on the virtual assessment by means of telecommunications technology where no in-person physical examination or in-person premise visit of the animal(s) or group of animals by the veterinarian takes place. Practicing via telemedicine does not alter a veterinarian’s existing legal and/or professional obligations.”2
The CVO goes on to describe telemedicine as a “method or mode of delivering veterinary medicine, rather than a new model of practice.”2 In other words, telemedicine does not fundamentally alter the practice of medicine; rather, it adds to the “toolbox” we are utilizing.
How does it work?
Each telemedicine platform has its own distinct structure. Some simply provide a software solution that allows a practice to offer its own telemedicine services to clients through the utilization of the clinic’s own team members. This option proved particularly useful amidst the pandemic when veterinary telemedicine became significantly more prevalent across Canada and beyond.
Presently, many veterinarians and practice managers report they are keen to facilitate telemedicine services in their hospitals, but feel they are too busy to manage the introduction and implementation of a new service. As such, there is a growing need for third-party referral-type services to help bridge gaps in care created when a practice is not able to accommodate increased client demand.
Recent years have seen the establishment of several teletriage and telemedicine services that work directly with animal hospitals (such as Canadian companies, Smart.Vet and Animal HealthLink), as well as multiple direct-to-consumer offerings where the interactions are client-driven and do not generally involve the primary care practice.
The partnership between a veterinary clinic and a virtual care service can come in many forms, but typically exists as a supplemental offering to allow veterinary professionals the opportunity to provide trusted care to their patients, 24-7.
In most cases, upon being referred by their family practice or a local emergency hospital, pet owners will either contact the virtual service’s registered veterinary technician (RVT) phone line to arrange an appointment, or book directly through a web-based platform. Most referred appointments are considered urgent care and, as such, are booked on-demand.
The first job of the RVT answering a referral call is to determine whether there is a critical need for immediate physical care. There are triage criteria that must be fulfilled to meet this requirement for direct transfer by these RVTs. If a patient does fall into the direct transfer “bucket” of cases, the RVT will help to facilitate physical care for this patient. Clients who do not meet these criteria for transfer are offered a virtual appointment.
Once a consultation begins, the attending virtual veterinarian will establish a remote veterinarian-client-patient relationship (VCPR), conduct a thorough history taking, and then proceed with visual assessment over video. Videos, photos, and other supporting documentation (e.g. medical records, photos of prescription labels, etc.) can be uploaded. In the rare instances when a pet owner does not have internet access, a phone consultation can be performed in place of video.
Once the virtual veterinarian has made their assessment, a desirable plan of action is discussed with the client. It should be noted here that, just like in regular practice, based on the consultation alone, there are cases where there is an obvious diagnosis, as well as situations where the assessment is based on a list of clinical signs and associated differentials. Depending on severity/urgency of the case, or if more urgent hospitalization/diagnostics are required for appropriate treatment and management of the patient, an immediate transfer to physical care might be recommended. In these cases, the RVT team locates a veterinary hospital (usually the family veterinary clinic during regular/on-call hours or, otherwise, an emergency hospital) able to accept the patient. Records are transferred and the client is sent on their way with the pet.
The remainder of cases are managed completely remotely by the virtual team until the pet is able to see its primary care veterinarian. In many cases, the virtual veterinarian can prescribe medication and can send those prescriptions to be filled at the local human pharmacy. Veterinary-specific medications can be dispensed through veterinary facilities when appropriate and if a certain set of criteria are met. It should be noted that controlled drugs cannot be prescribed using a VCPR created remotely in Ontario—likewise, it is important to remain aware of the specific rules and regulations related to virtual care and the ways in which these vary from province to province. (The authors of this article provide service for clinics operating in Ontario with expansions planned for British Columbia in the coming months.)
In cases where a referring clinic is experiencing a DVM shortage but otherwise has capacity and available support staff, a virtual care service veterinarian can recommend certain diagnostic tests (e.g. urinalysis, ear cytology, subcutaneous fluids) be performed at the client’s primary care hospital and can then relay results of any diagnostics to the owner, adjust the treatment plan accordingly, and schedule follow-up care as needed with the family veterinarian. This level of service further strengthens the bond between the pet owner and their primary care hospital and is far preferable to the patient being turned away for day-of care due to limited veterinarian availability.
What types of cases are seen?
Similar to telehealth call centres and 911 dispatch in human medicine, virtual veterinary care services manage a range of case presentations, directing them to the appropriate level of care (virtual versus in-person). Among the most common cases are injuries and musculoskeletal disease; wounds, dermatological issues, and allergies; gastrointestinal disease or issues; ocular and aural disease; respiratory and cardiac disease; toxicities; behavioural; and, finally, issues related to dental distress.
Telemedicine is advantageous for everyone involved—veterinarians, technicians, practice managers, animal care assistants, pet owners, and, most importantly, patients. Of course, the use of telemedicine is a teamwork approach, requiring collaboration between virtual veterinarians, RVTs, primary care clinics, clients, and pets.
Further, we cannot forget there are many situations in which telemedicine is the only reasonably available option for clients/patients. Many pet owners live in remote locations without sufficient access to veterinary care, while others do not have a primary care veterinarian because local clinics are not accepting new patients. Additionally, some clients have difficulty leaving their homes due to lack of transportation, limited mobility, or for personal health reasons. Weather, geography, and other factors have a significant impact on access to urgent care and timing of triage.
Telemedicine—though largely considered a form of “incremental medicine”—is, in actuality, invaluable for patient treatment and pet owner support.
Efficacy of veterinary telemedicine
Using a comprehensive medical approach, virtual veterinary care can be very effective. As veterinary professionals, we have all experienced in-clinic cases where a pet is too anxious or reactive to receive a full hands-on exam and, as such, we are left proceeding with empirical medicine. Other times, clients cannot proceed with a full set of recommended diagnostics, and medication trials are employed based on the judgment of the clinician. While a physical exam and thorough diagnostic plan are always ideal, this is not always possible, and the need to provide access to care for those who would otherwise be without is very high.
When veterinary telemedicine is discussed, too often there is a focus on the goal of obtaining a definitive diagnosis or a suggestion this service will replace physical care. This “all-or-nothing” thinking may be seriously limiting the scope of what can be achieved with telemedicine and is a potential (and certainly justifiable) cause of skepticism among veterinary professionals. The approach, instead, should concentrate on relieving a patient’s clinical signs in the short term whenever possible and bridging the gap until the patient can be assessed in-person. In cases where virtual care veterinarians are able to identify and resolve a problem, they are producing a set of differentials based on the history and visual assessment, as well as discussing next steps with the owner, including a potential diagnostic and treatment plan when appropriate.
While there are great benefits for veterinary telemedicine, there are, as well, some limitations. With these considerations in mind, practitioners are inherently more cautious when approaching cases virtually. Overall, veterinarians need to consider their own goals when using telemedicine within their practice. The service should be tailored to an individual practice’s needs, while abiding by the professional standard regulations. Some practitioners may prefer to use it for urgent care, while others may employ it only occasionally (i.e. if there is limited veterinary coverage on a particular day). Some may incorporate it into their day-to-day offering to clients for routine care. Different practices have their own specific needs and telemedicine is a tool to ensure continuity of care.
By and large, virtual care, when implemented appropriately, should not encroach on a patient receiving in-person care when that care is available and in the best interest of the patient. Reflecting on industry trends, Mark Cushing, JD, founding partner of Animal Policy Group, LLC, and co-founder of the Veterinary Virtual Care Association (VVCA), says, “Telemedicine is a tool, nothing more, and good veterinarians don’t turn into bad veterinarians when they decide to use it.”3
Overall, there is a distinct purpose for veterinary telemedicine. Through this service, we are able to better support the pet parent population and, by extension, strengthen the bond between pet owners and the veterinary profession.
Jackie King, executive director of United Veterinary Services Association (UVSA), says, “We always used to say animal health was 10 years behind human health…I think the pandemic has shown veterinarians can adapt quickly and will need to continue to adapt to keep up with demands from engaged millennial pet owners.”3
The current and projected growth of veterinary telemedicine is certainly exciting—not only is it here to stay, but it is poised to grow, likely exponentially.1
LEARN MORE ABOUT VIRTUAL VETERINARY CARE!
|For more information on virtual care practice in Canada, contact the Canadian Virtual Vet Care Association at www.cvvca.org.|
Sharon Quinn, DVM, is a 2004 graduate of Ontario Veterinary College (OVC). She has been working in companion animal general practice since that time and purchased her practice in Burlington, Ont., in 2006. In 2018, Dr. Quinn
co-founded Smart.Vet, a veterinary telemedicine software and service provider that works directly with veterinary hospitals and their clients. She has been involved with the Veterinary Virtual Care Association (VVCA) since its inaugural year in 2020 and was recently involved in co-founding the Canadian VVCA (CVVCA).
Christiane Orsini, DVM, is a 2014 graduate of OVC. She has a background in emergency and general practice throughout southern Ontario, and has been an associate veterinarian for Smart.Vet Virtual Care since September 2021.
Dr. Orsini is passionate about veterinary telemedicine and dedicates her time to help increase awareness within the professional community through webinars and seminars. She is a board member of the CVVCA.
1 Kastelic, J., and Ogilvie, T. “Veterinary Telemedicine is not only here to stay, its poised to grow and likely exponentially” Can Vet J. 2021 Dec; 62(12): 1277–1279. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8591578
2 “Guide to Professional Practice Standard: Telemedicine.” (June 2022) Available via the College of Veterinarians of Ontario (CVO) website: https://cvo.org/getmedia/57fa4e6f-3bbb-4596-9d89-c5f5a4772bd4/Telemedicine.aspx
3 Fountain Report (06-04-2021): Market Intelligence for Leaders in Animal Health. (Pages 4-7)
4 Mattson, Kaitlyn. (2019) Veterinary Care for All: Symposium discusses solutions to provide more access to veterinary care. Available via the American Veterinary Medical Association (AVMA) website, https://www.avma.org/javma-news/2019-09-01/veterinary-care-all