Using Telehealth and Telemedicine Technologies
Veterinary practices are increasingly using online technologies to gather and disseminate patient information. These developments have encouraged innovations that can enhance care, increase efficiency, and expand access. Familiarization with the definitions and types of technological medicine and adherence to state, province, and national practice, licensure, and pharmacy law is essential. Many states require an in-person veterinarian-client-patient relationship to be established first. The practice should ascertain security issues, protect client privacy, and allow for secure transactions. Notes and record keeping must be maintained as required by law. Check with your liability carrier to ensure coverage on planned activities.
The 2021 AAHA-AVMA Telehealth Guidelines for Small Animal Practice provide a detailed resource for implementing telehealth services in a veterinary practice.77 The components of an effective telehealth component in companion animal practice are shown in Figure 1, Components of Telehealth in Small-Animal Practice.
Telehealth can be especially helpful for the senior patient by increasing access to care in situations where caregivers may have disabilities, challenges with transportation or time off from work, or home care obligations or need consultations with specialists. The senior pet that is difficult to transport, anxious, painful, or fragile may be examined in less time and for less risk using telehealth resources. For the practice, telemedicine care can save time and expense, decrease appointment congestion, and improve workflow and ultimately work-life balance. Some practices allow clinicians to use a work-from-home option, which may expand hours and use a fee-for-service arrangement.
Having high-quality rechecks more frequently can improve patient outcomes by assessing response to therapy, progression of signs, healing of lesions, and any barriers to adherence. Access to current electronic patient data can facilitate better discussion, communication, and cooperation between those involved in the care.78
Video appointments may be used to gather background information before a clinical procedure or for a follow-up visit, especially with palliative or hospice care. The patient can be featured on camera to allow assessment of progress in pain control, movement, or wound healing. Often home environments allow a truer picture of the animal’s behavior.
Telemedicine examinations require planning to ensure compliance with state practice acts and optimal capture of accurate diagnostic information. Clinicians should always be mindful of the limits of telemedicine and provide informed consent for pet owners. Challenges may arise with the quality of images, the accuracy of the description of the concern, missed symptoms or physical cues, and diagnosis without diagnostic testing. Breaches of privacy, ransomware, or malfunctions are additional concerns.79 Clarity on the scope of care should be addressed with the caregiver during the visit, along with advice to follow up in person as needed.
Teleconsultation with specialists can aid patient care when specialty practices are hard to access. Check with your practice act regarding advice obtained from a veterinarian from out of state. Reports and information also may be transmitted by photo, audio, or recorded video methods. Clients may become more engaged in care with this real-time information and be more attuned to significant changes.
Pet wearable technology is rapidly expanding and may allow real-time monitoring of the senior pet. Smartphone apps that monitor pet health and activity are being developed and may further transform practice. Frequent inputs of blood glucose, weight, or cardiac abnormalities may enhance understanding of the patient’s condition and allow for improved treatment outcomes. Pain management may be improved with future artificial intelligence apps that can assess pain expressions and other aspects of movement. However, it is important to note that telehealth and telemedicine innovations are intended to augment, but not replace, in-person care.