Connected Care, Today and Tomorrow: A Virtual Roundtable on Virtual Care

As the year draws to a close, Trends arranged a virtual sitdown with five leaders in telehealth and virtual care to discuss their visions of what virtual care can be—and what it will take to get there.

“I can see a day when the veterinarian will be able to interact with the client/patient via telemedicine and then rent . . . [facilities] as needed. A WeWork for veterinary medicine.” —Aaron Smiley, DVM

Interviews by Constance Hardesty, MSc

When Trends started the Connected Care series in January of 2020, no one could have guessed how important telehealth and virtual care was going to be in the months that followed. Since the pandemic started, many—maybe most—practices have adopted this technology, often by necessity. As the year draws to a close, we arranged a virtual sit-down with five leaders in telehealth and virtual care to discuss their visions of what virtual care can be—and what it will take to get there.

Trends: We’ve heard a lot about the veterinarian-client-patient relationship (VCPR), but it is not the only regulatory control on veterinary medicine. How do you see virtual care affecting licensing requirements, interstate practices, or other regulated aspects of veterinary medicine?

James T. Penrod, CAE, FASLA: One of the major issues yet to be decided in virtual care is where the veterinarian needs to be licensed if the work occurs across jurisdictional boundaries. Is it where the veterinarian is practicing, where the patient is located, or both? The decision for veterinary regulatory boards must ensure that animals and the public are protected and the client has some recourse should something go wrong.

Because the licensure examination reflects current practice, we do not see changes to the North American Veterinary Licensing Examination or the Veterinary Technician National Exam happening until regulations permanently change to allow for the virtual establishment of a VCPR. If this happens, there may be a new role for the veterinary technician to play in being the eyes and hands of the veterinarian under the supervised care of the veterinarian.

Lori Teller, DVM, DABVP (Canine/Feline), CVJ: States are still all over the place with how they regulate their own licensees, so much will have to happen before we see widespread uptake of interstate veterinary medicine.

It is highly likely that questions will eventually appear on licensing exams and on specialty board exams. I do see telemedicine being incorporated into residency training programs.

We will also see more utilization of veterinary technicians visiting animals in homes or at farms, under an established VCPR with a clinic’s veterinarian, and facilitating recheck visits where it may be impractical for the animal to be brought to the veterinary clinic.

Jess Trimble, DVM: Offering reciprocity from state to state regionally would be a great way to ensure that care is still delivered responsibly with respect to regional animal diseases.

Trends: Over the decades, competition has reshaped companion-animal medicine in big and small ways. Other than “get on board or get left behind,” how do you see telehealth affecting the competitive landscape?

Brian Evans, DVM: As an independent practitioner, I see telehealth as a real opportunity to bond my clients to my practice and keep me as the center of their veterinary needs. If I can better serve my clients through paid telehealth options and prevent them from wanting to look elsewhere, not only am I saving on client-acquisition costs to replace that client, I am actually earning revenue in the process.

JT: Telehealth will help to level the playing field. Technologies will continue to decrease in cost as they increase in features. The number of reasonably priced, easy-to-use platforms will make it easy for any practitioner to pick up.

JP: We [the American Association of Veterinary State Boards (AAVSB)] don’t necessarily believe that virtual care will create huge competition among veterinary practices. What we are seeing today is that clients are loyal to their veterinarian.

If lower-cost virtual care is an option, the market will expand to a new clientele and potentially provide care to animals who were not receiving it before.

We talk about what veterinarians need to do to take advantage of telehealth, but at this early stage, the solutions aren’t perfect. There are crucial roles here for state boards, service providers, IT consultants, and marketers. What can they (or others) do to take telehealth to the next level?

Aaron Smiley, DVM: We can interact asynchronously via secure text and videos. Asynchronous telemedicine eliminates the need for scheduled telemedicine appointments. A client can send a message at her convenience and the doctor can respond when she has downtime in her schedule.

It is more conducive to veterinary medicine because our patients don’t always like to perform on demand. Taking a video of a pet’s ailment without the time constraints of a live video chat is much easier than trying to have the patient show clinical signs when the veterinarian is waiting.

BE: Reducing friction in the service will make the whole architecture better. Right now, the veterinarian is potentially using multiple platforms for scheduling, the online store, medical recordkeeping, etc.

I envision a client experience where I can evaluate, diagnose, and prescribe medication right there in the platform and have it delivered to the client’s door the next day. It should be just as efficient and easy as a dog coming into a clinic for, let’s say, an ear infection.

JT: Veterinarians and practice management systems need to agree on a universal medical coding system.

More transparency from liability-insurance companies regarding telehealth would ease the minds of many veterinarians. Few companies have made statements saying that they will support telehealth in the event of a legal issue, even though telehealth is fully legal under the majority of states’ laws.

Training for students in veterinary schools is critical to set up our future colleagues for success.

JP: In 2018, the AAVSB introduced a telehealth guidance document for our member regulatory boards as a resource to begin to have these conversations.

Our Canadian member boards are leading the way in this effort. The Canadian Council of Veterinary Registrars just approved a national policy statement on telemedicine. It provides guidance to the Canadian provinces on regulating telemedicine and includes a provision for establishing a VCPR remotely.

Ontario has the most experience with telemedicine to date and has not had any complaints related to virtual practice. Their council has been thoughtful in reviewing the regulations on an annual basis and trying to be proactive to quantify risks associated with virtual care.

LT: It would certainly help if the regulatory agencies could come to some type of consensus about what’s acceptable and what’s not with regard to telemedicine. We have to recognize that states that are more rural may have different needs from those that are more urban, but some level of broad consensus should be achievable.

Many rural areas do not have reliable internet connectivity. This has had a big impact on human healthcare, to the point that the Federal Communications Commission and the Department of Agriculture are expanding the infrastructure for broadband and healthcare in rural areas.

Platforms need to be easy to use, by both the veterinary team and the clients. Platforms need to minimize the number of buttons to click, have a font that is easy to read, and be intuitive to use. There should be various ways to integrate with practice management software systems, and easy ways to find information from previous telemedicine visits. Photos and videos should be simple to upload, and there should be a way to switch from chat-based visits to video visits.

Trends: Typically, we think of adoption as occurring in three stages: early adopters, mainstream integration, and second-generation improvements and integration. What would you like to see as second-generation innovations?

AS: Paid telemedicine will reduce our dependence on the physical clinic. I can see a day when the veterinarian will be able to interact with the client/patient via telemedicine and then rent an exam room, ultrasound, or surgery suite when needed. A WeWork for veterinary medicine.

BE: I would like to see more fluid communication and integration of spontaneous (paid) chats with both doctors and technicians when a client is looking for advice at times that are not scheduled and formal.

LT: I think remote and chronic disease monitoring are going to really take off. We are playing with some basic pulse oximeters, ECG devices, otoscopes and ophthalmoscopes, and stethoscopes that work on animals and can transmit information.

There are indications for use of these devices in the field, such as areas where access to care may be limited or during times of disaster, as well as for remote monitoring of things such as heart disease and seizures.

JT: The second-generation innovations are already starting—more options for client payments, more payment models for the clinic, additional client communication tools, and more.

Wearable and smart devices like data-collecting collars, connected litter boxes, glucose monitors, smart tattoos, or AI-supported video evaluations will show us that a patient is experiencing concerning symptoms long before they’re noticed by humans.

I’d love to see wearable technologies, marketing and engagement capabilities, and automated, personalized recommendations based on medical record data—but first, we must help practices to innovate and internalize the change.

Trends: Ideally, what do you envision as the promise of telemedicine for patient care?

BE: Most practices get the opportunity to interact with the average patient once to twice a year, if they are lucky. In those moments, there is too much information to cram in to fully optimize the pet’s health. With telehealth, we can give more pointed information frequently throughout the year in smaller, more convenient bites that makes the information more manageable.

JP: Telemedicine will expand access to care for those who are hesitant or cannot take their animal to a veterinary clinic. An initial virtual consultation could provide a lower-cost care option to the client for minor issues and allow the veterinarian to determine if there is a more serious issue that needs to be seen in person.

LT: If a client can utilize telemedicine to address concerns about a pet, then the veterinarian can determine if a pet needs to come in or if a problem can be handled at home. Clients may know their pets better than anyone else, but they are not always the best at knowing when something needs to be addressed.

AS: Patient care improves when the client gets more access to the doctor. Telemedicine gives the client more access to the doctor.

Meet Our Panelists

Brian Evans, DVM, is founder of Coastal Animal Hospital in Encinitas and Carlsbad, California. He is a member of the task force for the telehealth guidelines that AAHA and the AVMA are jointly creating for the veterinary profession.
James T. Penrod, CAE, FASLA, is executive director of the American Association of Veterinary State Boards.
Aaron Smiley, DVM, is president of the Indiana VMA, a member of the VetCor leadership team, and he practices in central Indiana. He is a member of the task force for the telehealth guidelines that AAHA and the AVMA are jointly creating for the veterinary profession.
Lori Teller, DVM, DABVP (Canine/Feline), CVJ, is clinical associate professor of telehealth at Texas A&M University.
Jess Trimble, DVM, is former chief veterinary officer of Fuzzy Pet Health. She is a member of the task force for the telehealth guidelines that AAHA and the AVMA are jointly creating for the veterinary profession.

 

Constance Hardesty
Constance Hardesty, MSc, is an award-winning writer specializing in veterinary trends, technology, and business management.

 

Photo credits: fizkes/iStock via Getty Images Plus; FatCamera/E+ via Getty Images; filadendron/E+ via Getty Images; photos courtesy of Brian Evans, Jim Penrod, Aaron Smiley, Lori Teller, and Jess Trimble

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