Regulators in Oregon have drafted telemedicine standards that allow practitioners to offer care online without having to first physically examine a patient, so long as the animal has been examined by any veterinarian within the past year and has the medical records to show for it.

As such, the proposed change would relax regulatory requirements for establishing a veterinary-client-patient relationship. VCPRs serve as the foundation of interactions between veterinarians and their clients and patients. Regulations in most states require veterinarians to physically examine patients before a VCPR can be established.

The Oregon Veterinary Medical Examining Board advocates for easing such restrictions, following in the path of human medicine, which is facilitating telemedicine in allowing physicians to establish relationships online without an initial face-to-face office visit.

In their proposed change to the state's Veterinary Practice Act, Oregon regulators would permit telemedicine at the "discretion of the veterinarian," even if the veterinarian hasn't personally physically examined the patient, so long as two criteria are met:

• The veterinarian has reviewed the records of another licensed veterinarian who has physically seen the animal within the previous year.
• It is possible to make a diagnosis and create a treatment plan without a physical examination.

The public has until 5 p.m. PST Dec. 31 to weigh in on the OVMEB draft changes. Comments can be emailed to Executive Director Lori Makinen at lori.makinen@state.or.us.

The board may vote on the proposed rule change during its Feb. 8 meeting in Portland.

Proponents of the change assert that telemedicine is the future of veterinary care, while critics support the long-held and revered idea that sound veterinary practice requires establishing a VCPR in person because animals cannot tell doctors how they feel. A face-to-face visit is needed, they say, because telemedicine can breed misdiagnoses and miscommunication even in human medicine. (The American Academy of Pediatrics and the American Telemedicine Association do not recommend telemedicine for children under the age of two because they are believed to be largely nonverbal.) 

The Oregon Veterinary Medical Association opposes the change. It states in a letter to board officials that a physical examination of a patient is needed as a foundation for remote care. Doing without, the association says, is "problematic" for patient and consumer welfare. 

OVMA President Dr. Connie White, a veterinarian who's spent much of her career in Portland, articulated the pitfalls of having to use another veterinarian's records to make a decision about a patient's medical condition — even when the animal is physically in the practice.

"I'm a former emergency vet, and it can be quite difficult to figure out what has gone on from just the chart notes," she said in an interview. "I think most of my colleagues would consider medical records to be insufficient for preliminary diagnosis and treatment recommendations for any new onset problem, and record review alone would be inadequate as the basis for a second opinion for a pre-existing problem."

By email, Makinen stated that the OVMEB was prompted to explore new telemedicine rules after two national veterinary groups adopted model practice act standards on telemedicine that directly conflict with each other.

Oregon's proposal to loosen VCPR requirements for telemedicine is consistent with a model put forth by the Association of American Veterinary State Boards. In contrast, the American Veterinary Medical Association doesn't support giving up physical visits for telemedicine. In August, the AVMA tightened VCPR parameters in its Model Veterinary Practice Act to preserve in-person examination requirements.

According to OVMEB meeting minutes, telemedicine has been on the agenda since mid-2018, and regulators have heard at least two presentations by telehealth advocates. Dr. Rolan Tripp, a self-described "telehealth pioneer" who authors articles on telemedicine and founded the company Veterinary Telecommunications, spoke to the board in October 2018. Nine months later, the board heard from Dr. Bob Lester, a former member of the Oregon regulatory board and current chief medical officer of WellHaven Pet Health, a practice group headquartered across the border from Oregon in Vancouver, Washington. 

Lester and WellHaven CEO Dr. John Bork told the VIN News Service in an interview last year that it was testing a number of telehealth applications that would allow for remote analysis of clinical signs. In the not-too-distant future, Lester said at the time, "[V]eterinarians will be able to have virtual work days from anywhere."

Global topic

Debate and activities on veterinary telemedicine are happening throughout the country and beyond. 

In California, the state Veterinary Medical Board is allied with the AVMA stance. Last month, California regulators issued a statement clarifying that telemedicine cannot be practiced by a licensee who lacks a VCPR established by a hands-on physical examination of the patient.

Anything less, regulators said, would constitute "unprofessional conduct."

"The proposed regulations are necessary to protect California consumers and their pets by ensuring they only receive telemedicine services after an appropriate VCPR has been established, thus ensuring the animals are provided with the best level of care," the CVMB stated.

Other states considering telemedicine parameters include New Jersey and Georgia.

The Royal College of Veterinary Surgeons, a regulatory body in the United Kingdom, has spent more than two years considering whether to loosen restrictions involving telemedicine without reaching consensus.

And parts of Canada already have incorporated telemedicine into veterinary practice. In 2017, the Council of the College of Veterinarians of Ontario approved regulations allowing veterinarians to establish a VCPR remotely, a change intended to improve access to veterinary health care.

White, the OVMA president, cautions against the unregulated spread of veterinary telemedicine. Unlike in human medicine, broad standards aren't in place to protect and guide veterinarians on how to engage in remote care. Another potential pitfall, she said, is the absence of data protections and laws governing the privacy of owners and their pets.

"My personal take is that direct-to-consumer telemedicine may be possible in the distant future, but right now, it's irresponsible," she said. "If you want to start doing telemedicine, you have to think, 'What are the rules?' And we don't have any of that."

The fact that many practices are owned and operated by non-veterinarians and major corporations elevates the importance of developing telemedicine standards, White said. External guidelines for telemedicine could protect veterinarians if their responsibility to patients runs counter to a company's objectives. 

"It can be very hard for an associate to practice with full autonomy, particularly if their job performance is assessed primarily by effect on shareholder value," White said.