Telehealth in Transition

Client apps, home monitoring devices, virtual consultations and remote triage are examples of burgeoning telehealth technologies altering the way veterinarians provide care. But as capabilities expand, the industry consensus on the safe and appropriate use of various telehealth modalities remains unclear.

As veterinary practices determine where they stand on telehealth, which products work best for them and how to refine their approach, industry representatives in technology, distribution and sales can play a supporting role. Understanding the technology and the legal, professional and cultural concerns surrounding it can help reps adapt to changing clinic needs.

What is veterinary telehealth?

Telehealth is a broad term encompassing several other tele-disciplines. According to the American Veterinary Medical Association (AVMA), telehealth describes the use of technology to deliver information, education or care remotely. Here’s a quick overview of terms sales representatives should be familiar with:

• Teleadvice: This includes general pet health guidance from veterinary professionals, often veterinary technicians, and doesn’t require a pre-existing veterinarian-client-patient relationship (VCPR) — which is usually established and maintained through annual exams. Teleadvice services are typically offered via a client app or over the phone.
• Teletriage: This service is available to pet owners who want to determine whether their pet’s condition requires a visit to an emergency or urgent care facility. Teletriage also does not require a VCPR and may be performed by credentialed technicians or veterinarians. Many veterinary facilities offer this service informally or through one of many popular client-facing apps.
• Telemedicine: This service is more involved than advice or triage. Telemedicine involves diagnosing and prescribing, which requires a valid VCPR. Under federal law and in most states, this relationship must be established through an in-person exam, although a few states allow virtual establishment.
• Telemonitoring: An offshoot of
  telemedicine, telemonitoring uses remote-monitoring wearables or other at-home tools. This service usually requires a VCPR so that the treating veterinarians can use the monitoring results to create or update a pet’s treatment plan.

The cons: The telehealth debate

During the COVID-19 pandemic, many teams turned to various forms of telehealth (including calling clients sitting in their cars) out of necessity. But as the dust settled, a debate emerged over the utility of this kind of care, prompting some to take a step back rather than explore all the options telehealth offers.

Still, this area of the industry continues to grow as new companies and services become available to meet client demand while also addressing real-world concerns about the practicality, legality and morality of providing this type of care.

The VCPR

The concern most people raise when discussing telehealth in the veterinary industry is whether veterinarians should be allowed to establish a veterinary-client-patient relationship (VCPR) virtually, without an in-person exam. The AVMA, along with its partners in the Coalition for Connected Veterinary Care, supports establishing the VCPR through an in-person visit, citing patient safety and public health risks involved with doing so virtually.

Industry and organizational leaders argue that a hands-on physical exam is absolutely necessary to establish a VCPR because patients cannot explain their symptoms, and client histories are not always reliable or thorough enough to rule out serious health conditions. The potential for misdiagnosis exists, which creates legal risks and moral questions.

The AVMA also has concerns that telemedicine in the veterinary field could begin to resemble the “pill mill” apps popping up in human health care. Bypassing an in-person exam increases the risk of inappropriate prescribing and contributes to the rise of direct-to-consumer models focused on product sales rather than patient well-being.

Additional concerns

Other reasons to be cautious with telemedicine include:

• Access-to-care issues: While it can help teams reach underserved areas, virtual care can increase financial and time costs for pet owners if the pet needs a follow-up in-person visit. In rural or underconnected regions, internet access may also be a problem.
• Workflows and staffing: From an operations standpoint, integrating telehealth tools means finding time and resources to retrain staff and rewrite protocols. Virtual care may potentially add to the burden already placed on overwhelmed teams.
• Legal gray areas: Practices that support telemedicine in theory may hesitate to adopt it when their state’s VCPR rules are unclear, or they become nervous about liability. Licensing board complaints related to virtual care may convince some veterinarians that it isn’t worth the risk.

The pros: Telehealth opportunities

Despite the objections and theoretical risks, telehealth is gaining ground across a range of clinical applications. Many practices already participate in the more commonplace teleadvice and teletriage services, even if they aren’t doing so intentionally. Answering general client questions unrelated to a specific diagnosis and advising pet owners on whether their pet should be seen are forms of telehealth.

These services are widely accepted as valuable client-support tools, and many clinics take them to the next level by using communication apps and platforms to enable two-way, asynchronous communication. According to the 2021 AAHA/AVMA Telehealth Guidelines, practices that adopt these platforms and use text, video or in-app messaging see better client engagement and compliance.

Once a VCPR is established in person, veterinarians can use telemedicine for:

• Rechecks
• Chronic condition management
• Medication monitoring and adjustments
• Post-op progress reports

Seeing these patients virtually saves time for the client and the veterinary team, offers convenience, and helps to reduce in-clinic traffic and general clinic chaos. Even better, it can generate additional revenue without placing undue stress on the team or its resources.

When paired with remote monitoring devices that clients can purchase or borrow for home use, virtual care can be extended to a broader clinical context. For example, monitoring an infectious patient in isolation at home or a diabetic dog in need of insulin adjustments supports a broader spectrum of care and access-to-care initiatives.

Telehealth helps to overcome common barriers to accessing veterinary care. A 2024 Open Veterinary Journal review found that 58% of clients couldn’t afford a local veterinary visit, and 25% lacked transportation. For these clients, remote care was the only feasible option.1 Additionally, telehealth might help overcome recent concerns with rising costs.

Emergency care, dermatology, behavior and rehabilitation are among the areas where telehealth adoption has accelerated. Clinicians in these fields are more likely to use asynchronous telecommunications, remote diagnostics and image sharing to support patient care. Telehealth can also help improve continuity of care and reduce visits for patients who are co-managed by a general provider and a specialist.

The representative’s role in the future of telehealth

Distributor reps play a vital role in a clinic’s day-to-day operations. They serve as a consistent, familiar liaison between software developers, manufacturers and distributors, and the practices they serve. Clinic leaders rely on trusted reps to help them choose and implement telehealth platforms, train teams to use them, and adjust workflows and product orders to meet changing client needs.

Because of their extended reach into clinic operations, reps can influence the future of telehealth across the profession. Understanding the importance of a VCPR, the regulations surrounding the VCPR in their state and the distinction between teleadvice, teletriage and telemedicine enables reps to become experts in emerging technology, including its benefits, limitations and legal boundaries.

As veterinary teams respond to changing client expectations, they’re looking for solutions. Industry representatives can position telehealth technologies as an answer to clinical challenges and continue building relationships with teams through onboarding, training and ongoing support.

Supporting telehealth in veterinary medicine

Veterinary telehealth is a work in progress. Practices are still figuring out how and where it fits, which tools are worth the investment and how to balance virtual and digital communication with hands-on care.

Because veterinarians are divided, animal health reps are likely to encounter a range of opinions and practices in the field. Telehealth should support and augment existing care, and reps can serve as a resource to help teams understand their state laws and implement meaningful change.

References:

1. Lundahl L, Powell L, Reinhard CL, Healey E, Watson B. A pilot study examining the experience of veterinary telehealth in an underserved population through a university program integrating veterinary students. Front Vet Sci. 2022;9:871928. doi:10.3389/fvets.2022.871928.

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istockphoto.com/PonyWang