A veterinary-client-patient relationship, or VCPR, can be established remotely, in some cases. Practitioners must determine for themselves when to use telemedicine as "a component of, or in lieu of, hands on medical care."
That perspective is laid out in the Model Policy for the Appropriate Use of Telehealth Technologies, a first-of-its-kind guide by the American Association of Veterinary State Boards, an organization that advises state licensing boards.
"Yes, this draft does allow veterinarians to establish a VCPR remotely," AAVSB Executive Director James Penrod said. "What the draft specifically says is that for the evaluation and treatment of patients, it's up to the veterinarian to employ sound professional judgment. Telemedicine is not appropriate for all cases."
The AAVSB policy, he said, is intended to offer proactive guidance for lawmakers on the telemedicine forefront. "State boards don’t have the ability to change statute; only elected officials have that ability," he said. "The idea is that, should legislation be introduced in the area, that consumers can receive care via telemedicine means, we can provide education to our elected officials."
The policy also upends the long-held and cherished idea that sound veterinary practice requires establishing a VCPR in person because animals cannot tell doctors how they feel.
"It looks to me like they're basically doing away with the need for a physical exam and are focused more on licensure and documentation," said Dr. John Daugherty, owner of a veterinary practice in Poland, Ohio. "Am I missing the importance of actually knowing more about the patient than can be gathered from your phone screen?"
In July, the American Veterinary Medical Association adopted a telemedicine policy that reflects the concerns Daugherty expressed. "Without a VCPR, any advice provided through electronic means should be general and not specific to a patient, diagnosis or treatment," the policy states.
Remarking on the groups' conflicting stances, Penrod explained that AAVSB and AVMA serve different constituencies.
"Our two organizations have different missions," he said. "The AVMA’s focus is on advocating for their members while the AAVSB’s mission focuses on public protection. As you recall from their policy, the AVMA indicated that they felt there currently was not sufficient evidence of telemedicine activities that would demonstrate that a doctor could establish a VCPR remotely."
Regulations in most states reflect the AVMA's stance, which has discouraged the evolution of remote veterinary medicine. AAVSB believes that the use of such technologies could make animal health care more affordable and accessible for consumers. "If statute is changed through the regulatory process, it will be critical to have model policy available to eduation legislators and ensure protection of animals and the pubic," Penrod said.
While AAVSB hasn’t released its draft telemedicine policy for public consumption, the document has been widely circulated among state regulatory boards and organizations in the veterinary landscape, including specialty groups and the AVMA.
"A veterinarian using telemedicine must take appropriate steps to obtain owner consent, establish the VCPR and conduct all appropriate evaluations ad history of the patient consistent with traditional standards of care for the particular patient presentation," the draft policy states. "As such, some situations and patient presentations are appropriate for the utilization of telemedicine as a component of, or in lieu of, hands on medical care, while others are not."
Thus far, AAVSB has collected 248 comments, including this from the AVMA: "We believe that 'traditional standards of care' require a physical examination of a companion animal patient, or familiarity with the animals and site in case of herd health situations, in order to establish the VCPR. Other provisions in the draft, however, would allow establishing the VCPR through electronic means, a potential inconsistency."
Supporters of the AAVSB's telemedicine push include Mark Cushing, an attorney and lobbyist whose client list includes the Veterinary Innovation Council, an organization started by the North American Veterinary Community in collaboration with Texas A&M College of Veterinary Medicine and Biomedical Sciences. NAVC, host of a major veterinary convention in the U.S., is working to position itself as a leader in the business of telehealth by developing tools for veterinarians to offer remote care.
In a keynote message to the NAVC in January 2017, Cushing, the political strategist, praised AAVSB for its efforts to address telemedicine: "It’s no longer a question of whether veterinarians will embrace telemedicine technologies, but when ... and how," he stated. "... What veterinary telemedicine needs is a regulatory road map that removes barriers to making telemedicine a reality."
Speaking last month by phone, Cushing added: "Human medicine started using telemedicine 20 years ago; now 48 states out of 50 have made it legal. Veterinary medicine is on the same trajectory."
Responding to the argument that remote care in veterinary medicine isn't comparable to human medicine because the patients can't speak, Cushing noted: "Neither can babies. And yet, telemedicine is permitted for pediatrics."
The American Academy of Pediatrics cautions that the episodic use of virtual health care doesn't provide patients with the same level of care received during hands-on visits. "Although such novelty care appeals to parents because it can be faster, more convenient, and more affordable than an office visit, the loss of continuity of care, quality of care, and patient safety shows why this telemedicine care model should not be embraced," reads the organization's policy on using telemedicine to address physician workforce shortages.
Apart from the issue of establishing VCPRs, the AAVSB model policy has drawn questions about its language regarding veterinarian-to-veterinarian consulting relationships.
"The AAVSB Regulatory Policy Task Force will be meeting at the beginning of June to consider comments received," Penrod said. "Depending on the extent of the changes, the task force’s next step would be to make a recommendation to the AAVSB Board of Directors."
The board, Penrod explained, will determine how to move the policy forward. AAVSB members could finalize it as early as September.
"Right now, it's just a draft," he said. "Let’s remember that."
Editor's note: This article was amended to include context from the American Academy of Pediatrics.