See the Full Issue
October 2024
Compassionate Care From Afar
Telehealth services are considered part of the solution for growing professional concerns such as access to care and workforce shortages. The list of cases that can be handled through telemedicine is long, and the opportunities to utilize technicians are many.
The Role of the Technician in Telehealth
Telehealth services in veterinary medicine have grown immensely over the past several years. This technology is considered part of the solution for growing professional concerns such as access to care and workforce shortages. When used appropriately, telehealth services can improve patient outcomes, enhance client satisfaction and bonding to the practice, and benefit veterinary team members.
Case Study: Part 1
Mrs. Smith has noticed that Snickers, her 12-year-old female spayed domestic shorthair, has been having urinary accidents. During Snickers’ annual preventive care examination a few months earlier, she and Dr. Brown discussed that Snickers was overweight but otherwise appeared healthy. Mrs. Smith calls Dr. Brown’s office to ask if there is anything she can do to keep Snickers from having accidents.
Dr. Brown’s office utilizes telehealth and connects Mrs. Smith with one of the clinic’s veterinary technicians, Susan, to discuss her concerns. Mrs. Smith has seen Susan during several previous appointments and is eager to answer Susan’s questions about Snickers’ urination behaviors, thirst, and appetite. Susan discusses the many possible causes for urinary accidents with Mrs. Smith and recommends an in-clinic examination. She discusses that laboratory testing will likely be needed so that Mrs. Smith is prepared for the appointment.
Mrs. Smith’s initial call and subsequent conversation is an example of teletriage, the most common form of telehealth in veterinary practice. All veterinary clinics perform teletriage and provide advice to pet owners (teleadvice) over the phone on a daily basis. These services can be performed by any veterinary team member and do not require a pre-existing veterinary-client-patient relationship (VCPR).
The Role of The Technician in Teletriage
“Telehealth is a tremendous way for technicians to put their knowledge to use and improve client compliance and patient care,” said Lori Teller, DVM, DABVP (Canine/Feline), CVJ, clinical professor of telehealth at Texas A&M University College of Veterinary Medicine. This starts with teletriage and teleadvice.
In most cases, “a technician can triage the case to determine if it needs to be seen immediately or if this is something that can be monitored at home for a period of time,” said Teller.
With their broad medical knowledge, technicians know what questions to ask of clients to get the information needed to make the best recommendation for an individual patient. Through teletriage, technicians may also be able to build on an existing relationship with the client that was established during previous in-clinic visits.
“Having technicians utilize telehealth with a client can be much more fruitful and satisfying than a random Google search and can further bond a client to your practice,” Teller noted.
Additionally, having technicians engage with clients prior to the appointment can increase compliance.
“When we explain the whys [behind our recommendations], it is so common for a customer to agree,” said Antoinette Martin, DVM, vice president of Virtual Medicine and Operations at Petfolk, a veterinary health care network.
Technicians understand the reasons behind the testing that the veterinarian recommends and the importance of the physical examination. Telehealth gives technicians the opportunity to translate this information into language a client will understand. Martin has observed “so much decrease in friction for our bookings and much more compliance for the recommendations that we’re making just by [having] that extra five minutes of conversation before the appointment.”
Case Study: Part 2
Snickers is diagnosed with diabetes mellitus during her appointment. Dr. Brown and Susan discuss disease management with Mrs. Smith after delivering the diagnosis. Susan teaches Mrs. Smith how to administer insulin and discusses insulin handling and dietary recommendations. Mrs. Smith prepares to leave the appointment with new food, insulin, syringes, a thick stack of printed instructions, and a fair amount of anxiety about whether she will be able to treat Snickers. To help support Mrs. Smith, Susan schedules a virtual technician appointment for a few days later.
At the beginning of the telemedicine appointment, Mrs. Smith shares that she is unsure if Snickers is getting all the insulin as she sometimes jumps during the injection. During the video appointment, Susan watches Mrs. Smith administer the insulin. She assures Mrs. Smith that she’s doing a great job and gives some tips for lessening the stress of injections for Snickers. They discuss additional questions and schedule Snickers’ next follow-up in the clinic. Susan notices that Mrs. Smith is much more relaxed by the end of their appointment.
“There are tremendous opportunities for technicians to use telemedicine in practice,” said Teller. “Virtual appointments with a technician between in-person visits can be used to monitor progress and evaluate compliance,” such as with the case of Mrs. Smith and Snickers. “Our technicians are extremely important in client education and in bonding clients to a practice,” she said. “Some clients are more concerned about which technician will be in the room during an appointment than they are about which doctor they’re seeing.”
The list of cases that can be handled through telemedicine is long, and the opportunities to utilize technicians are many. The limitations of what technicians can do through telemedicine are the same as in the clinic—anything except for diagnosing, prognosing, and prescribing medication. They can provide client education on disease management, troubleshoot medication administration, discuss diet, assess patient behavior, and more.
Telehealth is a tremendous way for technicians to put their knowledge to use and improve client compliance and patient care.Lori Teller, DVM, DABVP (Canine/Feline), CVJ
Educating Teams in Telehealth
Telehealth is a powerful tool that veterinary clinics can add to their toolbox to expand technician utilization and improve patient outcomes. But just like any new piece of equipment or new drug, we must critically evaluate how to use it safely and effectively. Team members should be trained on what types of cases are appropriate for virtual care.
Whether or not a VCPR exists with an individual client and patient is a crucial factor in what services can be offered. Teletriage and teleadvice can be used at any time, regardless of whether there is an established VCPR, as these areas provide generalized information. “No diagnosing, treating, or prescribing,” clarified Martin, “We’re simply educating. I kind of say if you can Google it, it’s probably in the realm of fair game.”
Telemedicine requires the establishment of a VCPR, as it is used to address the needs of an individual patient. There is ongoing debate as to whether a VCPR can be established virtually, but the AVMA states that “veterinary telemedicine should only be conducted within an existing VCPR.” Ultimately, the specifics of when telemedicine can be employed and how a VCPR can be established and maintained are governed by federal and state laws and regulations.
Clinics that offer telemedicine need to provide guidelines to their team members on which cases can be managed virtually. For clinics that are just starting to offer telemedicine services, Teller reminds clinics that “while there are so many appropriate use cases for telemedicine, you don’t have to start with all of them at the beginning.” She suggests picking a limited number of use cases to begin, such as postoperative rechecks or weight management cases. Clinics can then expand services over time as the team and clients become more comfortable.
Practical Tips for Telehealth Implementation
Implementing telehealth requires planning and team buy-in. “The major issues I see are incorporating telemedicine into daily workflows and appropriately charging for the service,” said Teller, “Both of these can be overcome, and that needs to be a team effort.”
When it comes to workflow, Martin suggested that when starting out, group telemedicine appointments into a single time block, whether that is confined to one day of the week or one part of each day. If doing a block of virtual appointments each day, Martin recommends “first thing in the morning, because you can’t get behind hopefully, or right after lunch for a similar reason. It gives you a little bit of a buffer to get in there and start on time.”
Martin acknowledged that “change management is hard.” She suggested that “rather than trying to get everybody on board, I usually say pick a person from each department” to be a champion for telehealth. This would include a customer service representative to handle scheduling and taking payments, a technician who can offer the service when talking to clients in the exam room and provide virtual services, and a doctor to oversee the advice and care that are provided as well as see telemedicine appointments. These individuals can keep telemedicine options at the forefront of their mind when talking to clients so that this type of appointment is offered when appropriate and scheduled correctly. They can also help to walk clients through any technology concerns related to a virtual appointment.
Adding telehealth services to your clinic may feel overwhelming, but both Teller and Martin encourage clinics to start small and build on their successes. There are numerous resources available for practices that want to add telehealth services, including the 2021 AAHA/AVMA Telehealth Guidelines for Small Animal Practice and the 2024 AAHA Telehealth Toolkit.
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The major issues I see are incorporating telemedicine into daily workflows and appropriately charging for the service. Both of these can be overcome and that needs to be a team effort.Lori Teller, DVM, DABVP (Canine/Feline), CVJ
Virtual Teams
Whether they know it or not, all veterinary clinics are already offering some level of telehealth through teleadvice and teletriage. Traditionally, these services are provided by team members over the phone or text message from the clinic. But there are a growing number of clinics that provide these services using remote team members. Sometimes, these team members are employed by the hospital and may spend some time in the clinic providing traditional services. Other times, team members may be entirely virtual.
Having virtual team members offers several benefits to clients, patients, and team members. Petfolk, a group of veterinary hospitals with locations throughout the United States, has a fully remote team of client service representatives, veterinary technicians, and veterinarians that provides support for all their brick and mortar hospitals. The majority of the virtual medical team’s work is fielding new questions from existing clients, said Antoinette Martin, DVM, vice president of Virtual Medicine and Operations at Petfolk.
“Customers are used to making that call and engaging the staff,” Martin said. Speaking with a virtual team member is not all that different from what clients are accustomed to.
A major advantage of using virtual team members is the lack of distractions that can occur in the clinic. Instead of trying to talk to a concerned client about their pet’s new lump in between checking in a client for their appointment and scheduling a follow-up appointment for a different patient, virtual team members can give complete focus to the client on the phone or video chat in the moment. This also allows the in-clinic team to more fully focus on clients and patients who are physically in the clinic without the distraction of constant phone calls. Ultimately, this can decrease stress for all members of the vet team and greatly improve the client experience and patient outcomes.