Over the past few years, veterinary medicine has evolved rapidly, and the global pandemic only accelerated that change. How and where we offer care to clients has been transformed with the expansion of telemedicine and implementation of curbside service. As the profession works toward a new equilibrium, some old routines will return and some new ones will develop. We can use this opportunity to push for—and assess—positive changes for the future. Changing with the times As we ponder what the new normal will be, telemedicine is likely to play an integral role in how veterinary care is offered. The use of telemedicine has increased on a massive scale during the COVID crisis, but its benefits were present prior to and still extend into post-pandemic practice. As Tim Atkinson, executive director of the New York State Veterinary Medical Society (NYSVMS) puts it, “If you were able to charge someone for a consultation outside the office, the only alternative was speaking on the phone. It’s what you were used to doing. You didn’t make any money because you could never effectively track invested time, and you weren’t able to see the pet. Now you can actually see the pet and earn a fee. So, I think people will find this valuable and will carry on.” Pet owners have adopted telemedicine enthusiastically, as it is convenient and helps patients remain calm during the appointment while in the comfort of their home. Back in 2018, a study on digital postsurgical rechecks published in the Journal of the American Veterinary Medical Association (JAVMA) found: “Owner-reported satisfaction with the recheck examination did not differ substantially between the telemedicine group and control group. In addition, responses from owners of dogs in the telemedicine group indicated a strong preference for use of videoconferencing for similar appointments in the future and indicated they thought their dogs were more comfortable during the videoconference appointment than what was typical for their dogs during in-clinic recheck examinations.”1 As more and more practices embrace telemedicine, those who do not may be at a disadvantage when looking to attract and retain engaged clients. Postsurgical rechecks are just the beginning for digital virtual care. Telemedicine is not designed to be a replacement for a hands-on physical examination, but when used as an additional tool to provide care, it can offer additional insights and perspectives. Michele Forbes, DVM, owner of Compassionate Care Animal Hospital in Ann Arbor, Mich., recently conducted her first new puppy and kitten appointments digitally remotely. Initially it was out of necessity, but after she saw how much value it added, she says she will continue to start all puppy and kitten relationships this way. “I have found it fabulous to go through preventatives, vaccines—all the preliminary advice—during the telemedicine consult,” Dr. Forbes notes. “The best part is the food. How many of us have asked what Fluffy is eating? ‘Well, it’s a purple bag and it’s got a cat or a dog on the front of it,’ the owner might tell you. Now they can actually go to their pantry, pull out the bag, and show you Fluffy’s dinner. You get all that information, with no follow up.” Even prior to the pandemic, many practices were adapting to changing client buying habits and looking for ways to generate additional revenue. Clients are currently purchasing 15 percent of pet medications online, and that number is expected to grow to 20 percent over the next two years.2 The pandemic further fueled online ordering, with “buy online, pick up in store” purchasing rising almost 250 percent in May.3 A robust telemedicine platform combined with an online pharmacy or curbside pickup service offers pet owners the same convenience, while keeping them within the practice ecosystem. Is telemedicine here to stay? Social distancing will continue to be a key driver in client interactions long after the initial threat from the virus has subsided. “While COVID is around—and this could be six months or it could be a year—curbside service is going to be with us,” Atkinson says. “It’s actually written into state guidelines. There is a document from the New York State Department of Agriculture and Markets that says, whenever practical, to conduct some sort of curbside check-in. I don’t think that is going away soon. Curbside service seems like it’s here to stay, at least for the foreseeable future.” Many state and federal organizations made changes to ease the adoption of telemedicine during the crisis. “There were about 10 states that opened up and allowed a virtual veterinarian-client-patient relationship (VCPR) to be created temporarily during the pandemic. The U.S. Food and Drug Administration (FDA), as well, suspended taking action against someone who used telemedicine to establish a VCPR in the case of extra-label drug prescription or veterinary feed directives,” says Jim Penrod, executive director of the American Association of Veterinary State Boards (AAVSB). “In the future, expect more states to consider moving toward virtual care-friendly practice acts. “If a veterinarian or a hospital can figure out how to use telehealth in an appropriate way, whenever they think they have enough information to make a judgment about the patient, they have been comfortable with their virtual decisions. But again, they are not shy to say, ‘No, this is something that will require you to bring the animal to the clinic.’ So I think it has put the judgment in the hands of the veterinarian. Of course, veterinarians have an ethical requirement and are making sure they are doing what is best for the animals.” At the start of the pandemic, the California Veterinary Medical Association (CVMA) instituted stricter rules for telemedicine use, stating a VCPR had to be in place for a specific condition, not just the patient, to deliver care remotely. Based on vocal reaction from California veterinarians, CVMA issued a new statement June 2 announcing, “As long as the other VCPR requirements have been met to establish the VCPR, including an initial in-person examination of the animal patient, the Order temporarily authorizes a veterinarian to use telemedicine to diagnose and treat an animal patient for a new or different medical condition.”4 While this reaction supports the trend toward increased access to virtual care, the changes are only temporary and there are some who are resistant. As Atkinson says, “The veterinarians I’m talking to are certainly looking forward to following up and conducting a full and thorough examination of the animal in case they missed something.” Yet, Penrod also warns things may move slowly. “To make these changes permanent, the state would really have to follow through on the process to change its rules or provide guidance. I know of at least one state that is currently proposing some rule changes to allow telehealth to occur. It can take up to a year to really change the rules because you need to get public comment, but this is something that potentially could happen,” he adds. Since 2018, veterinarians in Ontario, Canada, have been able to establish a VCPR digitally remotely as long as they: … “employ sound professional judgment to determine whether using telemedicine is appropriate in particular circumstances each and every time caregivers consider practicing via telemedicine, and only provide advice via telemedicine to the extent that it is possible without a physical examination. In doing so, veterinarians must consider whether practicing via telemedicine will enable them to satisfy all relevant and applicable legal and professional obligations, and meet the expected standard of care in any specific case.”5 Penrod states, “They have not received any complaints related to telehealth in Ontario and recently they actually updated their policy to allow writing prescriptions with a virtual visit.” Prior to the pandemic, a few states such as Colorado, Oklahoma, and Virginia had addressed the use of telemedicine. “There have not been any complaints—at least that I have heard of—based on a telemedicine visit,” he adds. This expansion of integrated technology into veterinary medicine gives practices an opportunity to more appropriately leverage highly trained technicians for triage and client education. A fully featured telehealth platform offers technicians the tools to liaise with clients independently, yet involve veterinarians or additional practitioners when needed. Practices can manage consultation follow up and seamless scheduling centrally, without worrying about additional charting and integration with the other management systems. Archival systems also provide legal protection from possible accusations of malpractice. As we envision the future of veterinary medicine going forward, we have the opportunity to realign practice values. Over the past few years, mental health has begun to achieve the attention it deserves. With only 24 percent of veterinarians under the age of 34 recommending their vocations to friends and family, it’s time to make a change.6 Utilizing technology such as telemedicine can set boundaries around when and how caregivers communicate with clients and allow flexibility where care is provided. It can help reduce workplace stress through tools for improved time management, communication, and productivity. No one can predict the future; the conditions for use (or nonuse) of a virtual VCPR will ultimately be decided by the veterinary community and pet owners. We cannot be certain changes in states such as California are permanent or that they will revert to pre-COVID requirements in a year or two. However, necessity is the mother of invention. While the coronavirus pandemic is the current catalyst for change, it is neither the first innovation in veterinary care nor will it be the last. The introduction of electronic medical records, digital radiography, and portable ultrasound have each, in turn, revolutionized the practice of medicine. The adoption of new technology, such as telemedicine, wearables, and the integration of large-scale data analytics is necessary for the evolution of veterinary medicine as a whole. As Penrod says, “Technology is something that needs to be embraced and will definitely help veterinarians in the future make better diagnoses.” Hilary Jones, DVM, graduated from Tufts Cummings School of Veterinary Medicine and completed a small animal rotating internship at Fifth Avenue Veterinary Specialist, now BluePearl Downtown. During her time as a primary care and emergency clinician in New York City, she was inspired to look for a better way to connect with her clients and their pets, leading to the development of TeleTails. Since its launch, as chief veterinary officer Dr. Jones has been working daily with veterinary teams across the country and organizations such as the American Veterinary Medical Association (AVMA), the American Association of Veterinary State Boards (AAVSB), and state associations to help veterinary medicine safely evolve digitally. She speaks on the benefits, opportunities, and economics of implementing telemedicine in veterinary practice. REFERENCES 1 Bishop, G., Evans, B., Kyle, K., and Kogan, L. Owner satisfaction with use of videoconferencing for recheck examinations following routine surgical sterilization in dogs. J Am Vet Med Assoc 2018;253(9):1151–1157. 2 https://www.aaha.org/publications/newstat/articles/2019-08/veterinarians-outselling-online-retailers-when-it-comes-to-pet-medsbut-not-for-long/ 3 https://www.digitalcommerce360.com/article/coronavirus-impact-online-retail/ 4 https://www.vmb.ca.gov/ and https://www.dca.ca.gov/licensees/dca_20_21.pdf 5 Professional Practice Standards. The College of Veterinarians of Ontario; September 2018. Accessed at: bit.ly/3i7rJvg 6 Lau, E. Survey: Majority of veterinarians don’t recommend the profession. VIN News 2018; Feb. 6. Accessed at: bit.ly/3k6UiuF
