NAVC KEYNOTE COMMENTARY What veterinary telemedicine needs is a regulatory road map that removes barriers to making telemedicine a reality. Hopefully, this article is a start. It’s written for the veterinary practitioner in any state in this country who asks a simple question: if telemedicine is a good idea for pet health care, then how do we make it happen? EXISTING CLIENT CHALLENGES When a veterinary–client–patient relationship (VCPR) exists, the veterinarian may communicate with the client in any way she chooses: in person or by telephone, internet, fax, Skype, carrier pigeon…you name it. All that matters, for regulatory purposes, particularly in the area of prescription medicines, is the veterinarian’s familiarity with the pet through a relatively recent in-person examination. The challenge of telemedicine in this context is one of staffing, pricing, technology, and standard of care requirements spelled out in state veterinary practice acts. Technology can be a key to client engagement, which is important because it drives client satisfaction and nurtures a long-term relationship between the veterinarian and the pet owner. These are important issues, but not the focus of this article. I will leave it to trade associations and technology providers to determine how best to engage practitioners with the array of telemedicine tools for existing clients. WHAT’S IN A NAME? Telemedicine is more than a telephone call; it describes the use of the internet in veterinary medical practice. The Federation of State Medical Boards (FSMB, fsmb.org) defines telemedicine as the practice of medicine using electronic communications, information technology, or other means between a licensee in one location and a patient in another location, with or without an intervening health care provider. The American Telemedicine Association (ATA, americantelemed.org) uses a shorter version, defining telemedicine as a tool to facilitate health care delivery… to augment, and not replace, the clinical practice, judgment, and the expertise of the health care provider. Insert veterinary before the words medicine or health care and you have veterinary telemedicine —a real-time electronic engagement among veterinarians, pet owners, and pets. NON-CLIENTS FACE REGULATORY WALLS Here’s the dilemma for the veterinarian brimming with enthusiasm and ready to reach out to new clients through telemedicine: If this practitioner attends a veterinary conference, he or she is likely to run headlong into a gale force of resistance asserting that a VCPR cannot be created through telemedicine . Every jurisdiction, except Connecticut, Alaska, and the District of Columbia, spells out the requirements for a VCPR, which includes an in-person physical examination of the pet. But here is the real-world challenge: DETERMINING THE DIRECTION To design a road map, we need to determine the direction of telemedicine in veterinary medicine. The 2 broad goals discussed most often are: 1. To provide familiar electronic tools to existing clients , which allows communication between veterinarians and pet owners after visits or in lieu of visits, if the situation warrants. 2. To reach out to pet owners who do not have a veterinarian and provide convenient and familiar tools that introduce them to the path of veterinary care for their pets. The first category of pet owners presents a different set of challenges than the second: put simply, the telemedicine road map for existing clients does not pose regulatory barriers, but this is not the case with telemedicine for potential clients. • Between 40% to 50% of pet owners— who love their pets —do not seek regular veterinary care. • While ads, social media, neighbors, friends, the Partners for Healthy Pets initiative, and every known tool of persuasion have implored pet owners to visit veterinary clinics, they consistently vote no. Hence, no VCPR. • As such, these pets receive no medical care, although their owners may access all manner of internet-based information to learn about their pets’ health. 110 NAVC KEYNOTE COMMENTARY
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