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April 2022
How Telehealth Crept Up on the Profession
Initial reluctance on the part of some practices to adopt telehealth has given way to a normalization of the technology. Now, it is almost expected for practices to offer at least some version of telehealth.
Reluctance Gives Way to Normalization
“I was never a big fan of it,” said Lee Allen, director of operations at AAHA-accredited Happy Tails Emergency Veterinary Clinic in Greensboro, North Carolina.
He’s talking about telehealth.
Or maybe a better way to put it is that Allen was interested in the possibilities of telehealth pre-pandemic but had several reservations. He was initially reluctant to adopt telehealth because he thought most of the available platforms were geared toward an “ask Dr. Google” model, plus he had issues with a lack of audits and controls with those models and felt they were totally separate from the clinic model.
He changed his mind and became an enthusiastic adopter during the pandemic—largely because those models had improved dramatically, he said. And in addition, Happy Tails had special needs.
Telehealth allows practices to provide general advice, education, and—perhaps most important—triage.
Strictly an emergency hospital, Happy Tails is open Monday through Friday from 6 p.m. to 8 a.m. and 24 hours Saturday and Sunday. They had no one covering the phones weekdays when they were closed. And the phones were ringing off the hook when they were open.
“Our CSRs were getting overloaded due to sheer call volume,” Allen said. “Historically the traditional model in the vet clinic is, if the CSRs can’t get to the phones when they’re ringing, somebody else tries to pick up, whether it’s management, the medical support team, the owners—whoever’s there.”
That was hard on everybody, particularly the medical team. “Our medical team was getting stressed out because they were having to stop their work on patients in order to answer the calls.”
And those calls weren’t 30-second calls, Allen noted: “It’s always anywhere from one minute to five minutes.” When he added up the amount of time that the medical team was spending answering incoming calls, he was horrified: Six months into lockdown, the Happy Tails medical team was spending anywhere from one to three hours a day being pulled away from medical care to answer phones. “That alone made the decision.”
Happy Tails hired GuardianVets, a Chicago, Illinois–based veterinary telehealth platform staffed by credentialed veterinary technicians, to handle their overflow calls.
“If nobody picks up after three rings, our system forwards the call to GuardianVets and they triage for us,” Allen said. The phone are set to forward calls 24 hours a day, whether Happy Tails is open or closed. Allen noted they’re averaging 600 to 700 overflow calls a month.
“Now my medical team is not answering incoming calls, so they’re able to spend that time taking care of the patients instead of getting caught on the phone,” Allen said. “That has been wonderful.”
And once Happy Tails adopted telehealth, they didn’t hold back.
The practice also uses Slack, an interoffice communication platform that integrates with third-party telehealth platforms, including GuardianVets. “That has been awesome because Slack is loaded on everyone’s mobile devices, so we can communicate with [all our] telehealth services through them.” Those other platforms include a texting platform to communicate directly with pet owners, and a teleradiology service.
And Happy Tails is preparing to implement yet another telehealth service that will add virtual rechecks and consults to their toolbox, but Allen said that’s on hold for the moment because he doesn’t want to overwhelm staff as it will involve a steep learning curve at a time when time itself is at a premium.
He said the new service won’t replace the other telehealth services but rather complement them. “It’s another piece of the telehealth puzzle.”
John Dillon, founder and CEO of GuardianVets, is well aware of Allen’s pre-pandemic reservations about the efficacy of telehealth platforms. “We thought pet owners would love flashy new apps,” he said. But they thought wrong. “Pet owners had app fatigue.”
But Dillon said telehealth providers learned to adapt during the pandemic, figuring out how to evolve to meet the needs of veterinary practices. Triage has proved one of the greatest needs: “Daytime overflow support and our afterhours triage services are growing quickly and helping many practices across North America that are overwhelmed and burned out.”
Different Platforms
Not all practices that adopted telehealth during the pandemic use dedicated veterinary telehealth platforms.
Heike Mayes, practice manager at AAHA-accredited Green Lake Animal Hospital in Seattle, Washington, said they didn’t have any misgivings about telehealth: “It had always been on our radar,” she said. “We just didn’t know how our clients would accept it.”
“In some appointments, people just have a lot of questions. They take a lot of time. Telehealth is a good mechanism for that.”
—KRISTINE MORTIMER, DVM
Green Lake adopted telehealth a year and a half ago when COVID was in full swing, they were doing curbside, and—like most practices—they were overwhelmed. And, as it turned out, “Our clients love it.”
But unlike Happy Tails, Green Lake didn’t go with a telehealth provider—they use a free teleconferencing app called Whereby and figured out how to adapt it to telehealth themselves. And clients love it so much that Green Lake has one associate veterinarian, Kristine Mortimer, DVM, doing telehealth appointments from home full time, five days a week.
Mortimer said she thinks one of the fears that some practices may have about adopting telehealth is that if people get used to telehealth appointments, “they’ll stop coming into the practice.” In her experience, that hasn’t happened.
Mortimer went into the practice on a recent Friday and was surprised at how many clients and patients she’d seen in telehealth appointments had scheduled in-clinic appointments that day. “I was pleased to see that a lot of clients were using all options that were available, not just choosing one over the other.”
Mortimer appreciates that not all cases are appropriate for telehealth, and she reviews each day’s cases before she starts work. But now and again, one slips by.
“I’ve had a couple where I’ve called the hospital and told them, ‘This is not going to work.’” Sometimes she knows before she gets on the call, but sometimes she won’t know until she’s in the middle of the call. “Sometimes when I’m on the call itself, I’ll recognize that this is something that really needs to be seen in the clinic.”
She said that happens in maybe 5% of cases. One recent example: Green Lake was seeing a lot of kennel cough last winter, which Mortimer calls a pretty good candidate for a telehealth appointment: “It keeps the patient out of the hospital where they might infect other dogs.” But a brachycephalic dog with suspected kennel cough was scheduled for a video appointment. “After I listened to the dog on video, I could tell [the symptoms suggested] pneumonia, and we needed X-rays.” She had the client take the dog to Green Lake for an in-person visit.
Mortimer said Green Lake is “still working out” how they best use more telehealth in the practice, and noted that Seattle has a very tech-savvy pet-owner population that appreciates the possibilities of veterinary telehealth. “Our clients like feeling that they’re in control.” That’s been especially true during the pandemic when so much has seemed out of their control.
Mortimer says the biggest advantage of telehealth has been the degree to which it’s reduced stress in the hospital. “An emotional burden has been lifted from our staff,” she said. She cited the sheer number of cases that don’t have to go through the hospital. “No check-ins, no pre-exams, no infectious patients. No having to close off a room for the rest of the day. Telehealth streamlines the process.”
And, it gives her more time to spend with clients. “In some appointments, people just have a lot of questions,” she said. “They take a lot of time. Telehealth is a good mechanism for that.” When the doctor answering those questions is on a video call, a tech doesn’t feel rushed. “They’re keeping to a schedule, too. It’s out of sight, out of mind on some of these telehealth appointments.” The techs can focus on the more technical problems. “I don’t have to move from room to room. In a half-hour appointment, I can go the full half hour, answering questions with no interruptions.”
“I would never be able to have some of those conversations in the clinic,” Mortimer said. “You’re just too rushed.”
Allen feels her pain.
He said that just being able to manage call volume has had a huge effect on moral at Happy Tails. “It’s made things a lot easier. Staff aren’t constantly running around like chickens with their heads cut off.” Allen said that support alone has enabled them to be better in their jobs because it’s helped them manage workflow efficiencies: “It makes everything much more efficient. Staff isn’t feeling rushed. They feel like they can finish their tasks without interruption.”
And all of that contributes to job satisfaction.
He said it has a very real trickledown effect, and it starts with the medical team taking care of patients. “Now they know that they’re not going to constantly be interrupted. So they can focus on their patients, thereby again increasing our workflow efficiency.”
“And the clients love [telehealth] because there’s all kinds of different platforms for them to feel like they can stay in contact with us,” he added.
Keeping Boundaries
“We still want to have boundaries,” Allen noted.
And he said that’s another powerful advantage of the telehealth platforms available to practices today. “We’re able to keep those boundaries by filtering the communications coming in to us by saying, ‘OK, this we don’t have to answer right now; this we can answer tomorrow; and this we need to answer immediately.’”
“We’re still able to keep those boundaries, but [at the same time we] give the perception to the pet owners that we are available 24 hours a day,” Allen says. “That’s huge.”
Allen plans to keep using telehealth at Happy Tails post-pandemic and he boils it down to three main reasons:
- It increases client satisfaction
- It increases job satisfaction within the team
- It improves their brand
Allen can’t emphasize this last point about improving the brand enough. “We can’t forget this. The client feels more positive energy because we’re meeting their expectations,” he said. “And in the end, from a business owner standpoint, this increases our market share. And ultimately, our revenue, because it drives and directs our business.”
He doesn’t anticipate that changing that anytime soon. “Call volume is not going to go down,” he said.
“The number one advantage is convenience,” said telehealth expert Lori Teller, DVM, DABVP. An associate professor of telehealth in the College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, and president-elect of the American Veterinary Medical Association, Teller said that clients like telehealth. “Especially for triage situations where they’re not sure if their pet needs to be seen right now, in the next day or two, or is there something that can be done at home and avoid a visit to the veterinary hospital.”
And, Teller added, “We know that clients are willing to pay for this convenience.”
“Veterinarians who have adopted telehealth also like that they can do some rechecks virtually, provide client education through this modality, and help triage cases to avoid unnecessary trips to the ER,” she said. “This alleviates the burden on our ERs, saves our clients money, and keeps the revenue in the practice.”
But What About the VCPR?
Make no mistake, the veterinary-client-patient relationship (VCPR) is still an issue in telehealth, but maybe less than initially thought, said Teller.
“There continues to be lots of discussion about the VCPR,” she said. “[But] for most practitioners providing telehealth services, it is not as dramatic as some would have you believe.”
She believes it’s still important to know both the federal laws regarding telemedicine and the laws in your state, which can differ.
But that said, “There’s a lot you can do without a VCPR.” Teller mentioned that’s something many practices discovered during the pandemic, “when adopting aspects of telehealth helped many keep their doors open and keep valued employees on staff.” Telehealth allows practices to provide general advice, education, and—perhaps most important—triage.
That’s definitely true of Happy Tails. And while Allen’s enthusiasm for telehealth might be fervent, he’s not alone in his appreciation.
“I don’t want telemedicine to go away,” said Green Lake’s Mortimer. “People have wanted this for a long time.”
She needn’t worry, said Teller. “We’re seeing a decrease of utilization since the peak of the pandemic,” she conceded, but added that its overall uptake and growth will continue, albeit at a slower rate. “I think most practices that have embraced telehealth during the pandemic will continue to utilize it at some level.”
One way or another, said Teller, “Telehealth is most definitely here to stay.”
Tony McReynolds is AAHA’s NEWStat editor. |
Photo credits: Inside Creative House/iStock via Getty Images; AndreyPopovi/iStock via Getty Images; tickcharoen04/iStock via Getty Images