Telemedicine and the Pandemic: Where Are We Going, and Where Have We Been?

In response to the pandemic, the FDA cracked open the door to veterinary telemedicine without a normal veterinarian-client-patient relationship. Veterinary legal expert Charlotte Lacroix, DVM, JD, looks ahead.

Now that people have experienced it, telemedicine will gain traction. It’s like tasting a new food for the first time and discovering you like it.

In response to the pandemic, the US Food and Drug Administration (FDA) cracked open the door to veterinary telemedicine without a normal veterinarian-client-patient relationship (VCPR). Charlotte Lacroix, DVM, JD, looks ahead.

Interview by Constance Hardesty, MSc

Trends: For all of us, on a personal level, nothing good can possibly come from the COVID-19 pandemic. But some veterinarians have called the opportunity to practice telemedicine a silver lining in a very dark cloud. What do you see?

Charlotte Lacroix: Because of the pandemic, more doctors and clients turned to telemedicine. Now that people have experienced it, telemedicine will gain traction. It’s like tasting a new food for the first time and discovering you like it.

Take Zoom. Everyone’s using it now. A lot of people never used videoconferencing before the crisis because they didn’t need it. Now they’re comfortable with it. The pandemic may have created new demand for the technology.

Coming out of the crisis, I hope our experience will prompt state boards to look at telemedicine more carefully as a sound approach to veterinary medicine in general rather than as an emergency stopgap.

Trends: Social distancing made telemedicine necessary, but it’s not risk-free.

CL: Look, every new technology introduces new risk and new harm. It’s just a fact of life.

Before we used radiology, there was no danger of radiation exposure, no danger of misreading an image. But the benefits of new technology far outweigh the risks and harm.

We’ve been through this. We know how to adopt new technology. We mitigate risk with best practices, protocols, training, and practice. We have successfully adopted radiology, underwater treadmills, new pain-management regimens, and new surgical techniques.

Telemedicine is another form of technology that veterinarians will learn to use safely and with standards of care.

Trends: The FDA guidance released in March temporarily relaxed the VCPR requirement for prescribing extralabel drugs and issuing feed directives. Did the FDA open the door to abandoning the VCPR?

CL: The FDA action was limited. State veterinary boards regulate the provision of medicine. The combination of FDA guidance and some states relaxing their VCPR requirements may have an effect, but it’s too soon to say what that might be.

Trends: In many states a VCPR—generally taken to mean seeing the pet in the practice within a year—is a prerequisite for telemedicine. You’ve advocated for eliminating that requirement. Why?

CL: First, it’s important to remember that a lot of telemedicine tools, like videoconferencing, were not available when the states established the physical exam as a necessary component of the VCPR. So, in today’s context, you have to ask, “Is the physical exam always necessary to establish a diagnosis and treatment plan?”

Veterinarians are more than capable of determining case by case whether they need to see a pet for a set of presented circumstances. I trust my professional colleagues to decide whether a physical exam is necessary now, 48 hours from now, or three weeks from now, just as they decide whether and when a radiograph or an ultrasound or bloodwork should be done. Veterinarians make decisions like this every day.

Clients who want telemedicine—think millennials, cat owners, the 65% of seniors who have smartphones—are going to go to practices that provide it.

Trends: As veterinarians adopt telemedicine, what’s to stop them from poaching one another’s clients?

CL: There are a couple of things at work here.

First, veterinarians are still fully responsible for their decisions and actions. If a telemedicine consult doesn’t provide enough information to make a diagnosis or to assess how a treatment is working, you have to say, “I’m sorry, Mrs. Jones, but I can’t get enough information from this videoconference (or photo, or text). You’ll have to bring Fluffy in for an exam.”

Second, this is about providing the best consumer experience, not “stealing” customers. Even before the pandemic, customers were pursuing telehealth and teletriage. Clients who want telemedicine—think millennials, cat owners, the 65% of seniors who have smartphones—are going to go to practices that provide it.

If you want to win or keep those clients, adopt telemedicine. If you resist telemedicine, you’re going to be left out of the equation—not because someone else is poaching your customers but because customers are going their own way without you.

Trends: Clearly, you believe it’s time to pivot to telemedicine. What’s your advice to practices?

CL: I recommend every veterinarian in the country adopt telemedicine for rechecks. Veterinarians need to start implementing telemedicine right now so their practices don’t get left behind. 

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