According to the AVMA, telemedicine is “a subcategory of telehealth that involves use of a tool to exchange medical information electronically from one site to another to improve a patient’s clinical health status.” In the equine veterinary field, this could include using a Zoom meeting to communicate with a client or video to visually observe a horse that has a concerning lameness via a cell phone. It could also encompass sending images or other data electronically to a specialist to get an opinion. Most equine veterinarians are utilizing technology in these ways, and thus are using telemedicine already.
Telemedicine can be a useful tool to triage an emergent issue, or simply to communicate more effectively with a horse owner. Facilitating communication, diagnostics, treatments, client education, scheduling and other tasks through electronic means can increase efficiency as well as client satisfaction.
It is important that practitioners are in compliance with the laws of the state in which they are licensed to practice veterinary medicine. Telemedicine may only legally be conducted when a veterinarian-client-patient relationship (VCPR) exists. General information can be given by electronic means at any time, as long as the information is not specific to the medical issues of any one individual horse. For instance, a doctor could opine to a client by email or text that any eye issue of a horse should be examined by a veterinarian without delay. However, in an emergency situation, a veterinarian can give advice on actions to be taken until the animal can be examined. As the AVMA states, teleadvice can be defined as “general advice that is not intended to diagnose, prognose, treat, correct, change, alleviate, or prevent animal disease, illness, pain, deformity, defect, injury, or other physical, dental, or mental conditions.”
Benefits of Virtual Services in Veterinary Medicine
Triage via electronic means is becoming much more common in equine veterinary medicine. By evaluating the horse owner’s history and description of the current clinical signs of their horse, often accompanied by photographs or video, a veterinarian can usually determine the urgency of referral for care, even though a diagnosis is not made. For example, a photograph of a wound in the vicinity of a synovial structure accompanied by a mild lameness would generate an emergency visit for evaluation and treatment. In contrast, an image of a hoof with a small piece of wall broken off, accompanied by no discernible lameness, could result in a delayed visit or a recommendation to involve the patient’s farrier. When done carefully, teletriage is a safe and appropriate means to minimize emergency visits, benefiting both veterinarians as well as clients.
As more wearable devices are developed, monitoring patients from another location may increase. For years, breeding farms have utilized the Foal Alert system, and new systems have been developed that will alert veterinarians or horse owners that the horse is in lateral recumbency. Heart rate monitors are commonly available, and new companies are introducing innovative products each year. For example, PonyUp Technologies offers a specialized wrap boot that is fastened on the horse’s leg and provides remote, continuous, non-invasive, real-time monitoring of cardiac function including pulse and central blood pressure, along with respiration. These monitoring devices are another telehealth category.
Telemedicine in Human Medicine
The COVID-19 pandemic accelerated the trend of telemedicine both in the human and veterinary fields. As equine practitioners experienced an increase in the demand for their services, and often found it difficult to hire additional associates and staff, developing new ways to work more efficiently allowed them to provide care to more patients during that busy time.
In 2021, Eleanor Green, DVM, DACVIM, DABVP, and Richard Markell, DVM, MRCVS, MBA, spoke about telemedicine at the 67th Annual AAEP Convention in Nashville. Utilizing statistics from the human medical field, they showed that telehealth developments are so widespread that it is inevitable that people will expect the same level of care for their animals in the future.
They reported that in 2020, 97% of physicians were utilizing telehealth; in rural areas its use increased by 54%; and Medicare recipients receiving care by remote means increased from 13,000 to 1.7 million per week. Three quarters of physicians said it provided better patient care than in-person visits, because the patients could be seen in their home environments, where additional information could be observed. Three out of four patients expected their doctors to provide telehealth appointments, 85% were very satisfied with them, and 50% would change primary caregivers in order to have the opportunity for video visits.
In human medicine, video appointments are now an established source of additional revenue that adds to the bottom line. Both doctors and patients judge telehealth as efficient, reliable, convenient and accessible, even in rural areas. According to Dr. Green, “Telemedicine will not replace veterinarians, but veterinarians who use telemedicine may replace those who do not.”
Pitfalls to Adoption in Veterinary Medicine
Despite the success of telemedicine in the human medical field, equine veterinarians have been slow to adopt formal telemedicine systems because they have often been giving these services away for years for free. Many are averse to changing how things have always been done for fear of losing clients. The top concerns of veterinarians about adopting telemedicine include regulatory liability, client acceptance, staff adoption, technology and cybersecurity. In a survey conducted in late 2021, the question was asked, “Does your practice do any telemedicine, including assessing patients by text, video, photographs, Zoom meetings or other means?” Responses were about equally divided between Regularly (23.8%), Occasionally (30.6%), Rarely (21.2%) and Never (24.4%). When asked about charges for telemedicine, 78.9% of respondents reported that no fee was charged; 13.1% said they charged per time increment; and 8.1% replied they charged a set price regardless of the amount of time spent.
When offering a telemedicine service, you need to market the service in a way that encourages clients to use it, have a mechanism to easily schedule appointments, have a method for collecting payments, have a standard way to conduct the “visit,” and have an efficient way to create the medical record entry. One of the difficult aspects of telemedicine is properly documenting the encounter in order to have a complete medical record. Here is where a telemedicine platform comes in handy. As virtual interactions with clients have become more ubiquitous, companies have stepped into the gap and developed a variety of service applications. You certainly do not need a special platform to provide value to your clients, and you can document visits with screen shots and handwritten notes. However, a telemedicine application can make the documentation nearly seamless and allow you to easily monetize your time providing the service.
If you do decide to try a telemedicine platform, you should look carefully at all options through the lens of your clients. The use of the platform should be easy and require no technological expertise. The interface should be simple and clear, allow payment options, and allow easy documentation of the visit. The cost should be affordable for your practice for the number of times you believe the service will be utilized. You should explore whether multiple doctors can utilize the application simultaneously, whether confidentiality and security are robust, and whether an integration with your practice management software is offered.
If you don’t want to utilize a paid platform, appointments for virtual visits can be made with your receptionist, just like in-person farm calls are scheduled. The doctor can then utilize free meeting options like Zoom or Google Meet, and open these applications on a phone or laptop. Medical records can be created in the same fashion as if the veterinarian were there in person. Invoicing for these appointments can be created as the medical record is entered into the management software, and e-mailed or mailed by the postal service to the client in the practice’s usual way.
Considerations for Providing Telemedicine Services
To best utilize telemedicine in your practice, you need to understand how you intend to provide telemedicine services. Will you create a list of appropriate situations or cases, so your whole team is on the same page? Are you limiting telemedicine to rechecks? Or are you allowing its use for new issues? Determining your price list for different telemedicine services before beginning to offer them is essential. Because your time is valuable and limited, giving free advice limits your income and your practice’s success. When does giving advice need to be an official telemedicine consult?
Times are changing, and while adopting new strategies can be stressful, ultimately, they can help your practice excel. Instituting consulting fees for this service is essential, as professional time and expertise has great value. With a paucity of associates looking for new positions, many veterinarians are facing more demand than they can comfortably handle. Decreasing time spent traveling by utilizing technology to evaluate and triage patients from afar can help reduce stress and increase client satisfaction. Change is hard, but it can bring a positive impact on your practice and your life.
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