Most pet owners are devoted to their furry companions, but even the most responsible ones can encounter barriers to getting an animal to the vet. These might include financial limitations, being overwhelmed with work and family responsibilities and struggling to find the time for an appointment, needing to arrange for transportation and more. In situations like these, televeterinary services can assess what kind of care may be needed and if the vet will need to see the animal or if treatment can be done remotely. This can improve the quality of life for both pet owners and animals.
Telehealth has been on the rise in the medical field, but in the veterinary world, although similar services have been available in some areas for several years, adoption of the approach has lagged behind. However, the rise of COVID-19 and the associated risks, including those created by the possibility of animals themselves catching the virus, has led to a surge in this formerly slow-growing area.
Telehealth, Telemedicine or Teleconsulting?
These words, and the first two in particular, are often used interchangeably, but it is important to understand the differences in them. Telehealth is the umbrella term for any kind of health service that is delivered remotely. People might imagine telehealth as being a fairly high-tech interaction involving, for example, consulting with a client over video, but in fact, much simpler actions can be considered performing telehealth, including
- sending a text checking on a pet’s condition
- remote monitoring of an animal who is in the clinic
- photos and videos provided by the client of the animal’s behavior or of a wound or post-op site
Telemedicine is generally what people are thinking about what they consider the larger category of telehealth. This is when the veterinarian uses tools to consult with a client in some way as part of the overall veterinary practice. An example might be using a video conferencing tool to visually examine a pet for a surgical follow-up.
Teleconsulting is when a veterinarian uses the same types of tools to consult a specialist about a particular case.
Televeterinary services are, of course, the above services as practiced by veterinarians.
Telehealth and Legal Requirements
Telehealth is a supplement to veterinary care, not a replacement for it. It can be useful in the following situations, among others:
- determining whether a veterinary visit is necessary
- follow-ups after treatment, including an operation
- addressing behavioral problems
- monitoring the health of a pet with a chronic or terminal condition
In fact, in most states, laws regarding veterinarian-client-patient relationships did not permit telemedicine to be used to diagnose or treat conditions. However, a decision by the U.S. Food and Drug Administration on March 24 suspended the requirement for an in-person examination to reduce interaction because of COVID-19. While some states may have stricter rules, many have also relaxed regulations so that veterinarians and their clients can remain safe while still ensuring that pets get the care they need. The American Veterinary Medicine Association has issued guidance regarding COVID-19, including on telemedicine, and recognizes the changing nature of state regulations although its policy still recommends that only existing patients should have televeterinary consults.
Working with a veterinarian is different from getting a consultation from one of the third-party providers. These 24/7 services can only offer general advice, but they can be a source of assistance to worried pet owners in both normal and pandemic times, potentially saving them a great deal of money by letting them know that a condition does not require an emergency vet and can wait until a regular appointment is available. A telemedicine consultation, whether with a vet or a third-party provider, can also give an owner the information needed to keep the pet as comfortable as possible whether or not a later in-person appointment is scheduled.
Where to Begin
A veterinary office that is not already using telehealth does not have to bring in a full-scale program from the start. Depending on the size of the practice, the best way to begin is with just a handful of clients and perhaps one or two veterinarians. Telehealth can be used for minor cases at first. This creates a low-risk atmosphere to find out what works best as well as what doesn’t. Expansion should be slow and methodical and conducted in accordance with state law.
The fee paid by clients for telemedicine is generally split between the veterinarians and the telehealth platform. When an in-person appointment is a follow-up from a telemedicine consultation, the cost, if any, of the consultation is often subtracted from the cost of the in-person visit. Some veterinarians do not charge for brief consults or first exams or offer them as part of as a package.
Missed or delayed diagnoses are always a risk when it comes to medical care for animals or humans, and even the best doctors cannot always diagnose a condition as accurately or as quickly as is ideal. However, there are a few risks specific to telemedicine that both veterinarians and clients should be aware of. A lack of adequate medical history can be a problem, which is one reason regulatory bodies consider practicing televeterinary medicine only with existing patients to be so important. Time zone issues could lead to dangerous delays. Technology is not perfect, and images may occasionally be insufficient for making an accurate diagnoses. For these reasons, telemedicine services include language that releases them from liability although at least two, whiskerDocs and TeleVet, report no claims.
Pets and COVID-19
Not every condition can be treated remotely. Veterinarians have developed protocols to protect themselves and their clients, such as social distancing and extra cleaning protocols, during the COVID-19 pandemic. Most also offer some kind of protocol for hand-off that is low- or no-contact, whether that is curbside pickup, a parking lot exchange or placing the animal in its carrier at the front door of the practice. This does introduce an additional risk element in ensuring that the animals is not able to get away and can be adequately identified.
While protocols were initially put in place to protect humans, there is some evidence that pets can also contract COVID-19. In New York in April, two domestic cats along with tigers and lions at the Bronx Zoo tested positive for the virus. So far, there is no evidence that it is easy for cats and dogs to contract it, they do not appear to become ill and they do not appear to spread it to humans or to other animals. However, as with most unknowns regarding the virus, caution is the watchword.
The American Veterinary Medical Association has recommended that people who have COVID-19 should try to limit contact with domestic and other animals.
Although it is believed that COVID-19 has its origins in markets in China where humans may have contracted it from animals, throughout the months of the pandemic, in areas where outbreaks have been tracked closely and linked back to their source, none so far have been associated with pets or other animals.
Telehealth platforms report significant growth in both veterinarians registering for telemedicine and in telehealth consultations when the FDA relaxed its requirements. Such large-scale changes that are beneficial to veterinarians, clients and patients may well remain in place post-pandemic although this may require new long-term guidelines and regulations.
Veterinary Telemedicine Post-COVID-19
While telehealth for pets has blossomed in the age of COVID-19, it can continue to grow and develop even after it is no longer driven by the necessity for virus precautions.
There are several categories of clients for whom access to veterinary telemedicine may be particularly beneficial:
- millennials and younger generations, who are comfortable with technology and accustomed to being able to do most things online
- pet owners who are largely housebound and for whom visiting a vet could involve multiple hurdles
- low-income pet owners who may be able to save significantly if they find out their pet’s condition does not warrant a vet visit or immediate medical attention
Of course, in all of these cases, telehealth is useful as a screening mechanism to determine whether further in-person treatment is needed. Pet owners must still be prepared to seek treatment, including emergency care, when deemed necessary.
The two main areas in which veterinary telehealth is likely to change in the years ahead are regulatory and technologically. The broader use of telemedicine and the relaxing of restrictions during COVID-19 might drive a faster reform of regulations, but there are also a number of other issues that veterinarians and other stakeholders must consider. These include dealing with liability and consent as well as looking at best business practices for revenue and workflow. In addressing these issues, it is also important that the advantages of telemedicine for clients, including convenience and lower cost, are not lost.
As for technology, tools for communication are only one part of the picture. Just as there are an increasing number of tools that can be used for remote monitoring and diagnosis for human health, the technology for veterinary telemedicine is expanding as well. Implants and wearable devices that offer up-to-the-minute data on pet health may gradually replace the once or twice yearly checkup, and while visions of the future home might not have included smart litterboxes alongside thermostats and refrigerators that are sensitive to your needs, this and every other element of a pet’s behavior can be monitored as necessary to provide the best insights for maximum health and quality of life.
Communication tools and technology meet to solve one of the major issues in veterinary telemedicine that makes it different from telemedicine for people: animals cannot explain what they are feeling. This is one reason that in-person examination is so important in veterinary medicine, but it is also a hurdle that technology may be able to address, at least in part.
An answering service can be an important element in the efficiency of veterinary telemedicine, both today and as the industry expands and changes in the months and years ahead. Contracting with an answering service that has staff specifically trained in the industry who can screen and manage calls relieves a practice from having to have such staff onsite at all times. An answering service can offer 24/7 coverage, something that is not possible for most practices. As the first point of contact for worried clients, a compassionate, knowledgeable answering service staff can be a critical first point of contact in an effective chain of veterinary telemedicine providers that are ultimately working in the best interests of the animals entrusted to their care.