Telehealth in Equine Practice
Opportunities, and obstacles, exist in this new frontier. Should equine practitioners invest in telehealth capabilities?
For Dr. Cristobal Navas de Solis, telehealth is not a new concept. For as long as people have been able to communicate remotely via the internet or the telephone to give advice about medical problems with horses, “then that’s essentially what we’re talking about when we talk about telehealth,” said Navas, LV, MS, Ph.D., Assistant Professor of Cardiology/Ultrasound and Internal Medicine (CE), University of Pennsylvania School of Veterinary Medicine.
It’s just the explosion in technology and accessibility to that technology that has many equine practitioners wondering how to incorporate these new tools into veterinary medicine (or whether to incorporate it at all). Navas discussed with Veterinary Advantage where it makes sense and opportunities for growth, as well as obstacles and concerns equine practitioners should consider.
Useful ways telehealth can be implemented in field service:
- Teletriage (broken bones, wounds)
- Rechecks (lameness, wounds)
- Monitoring chronic disease
- Ultrasounds with improved confidence (uncommon body parts)
- Real-time radiograph review by radiologist, neurologic gait eval, internal medicine
Opportunities for growth include:
- Access to remote areas; help more animals and vets
- New teaching/mentorship opportunities
- Less travel, more efficiency, and less carbon footprint
- Increase overall quality of care in the profession
- New revenue stream with good work/pay relationship
- Lost information/missing details due to inability to physically examine the horse
- Patient selections (which ones should practitioners include?)
- Business logistics such as integration are time-consuming and costly
- Possible lost revenue due to smaller number of referrals
- Telemedicine needs to be compliant with veterinary-client-patient relationship (VCPR) and state regulations
- Hard to monetize
Navas has spoken to many practitioners about using telehealth. Some worry that too much reliance on telemedicine could lead to low-quality medicine. For instance, one internal medicine specialist told Navas he felt he was providing bad medicine by doing tele-consultancy. “I am asked to respond to questions with half-baked histories of horses and no physical exam, and guess at the diagnosis or make treatment suggestions,” the internist said. “I know this isn’t how it is meant to be, but in my clinic, it’s how our tele-consultancy service is working.”
Another practitioner told Navas that it will be hard to have the idea accepted by people to pay for advice they already asked for and get (most of the time) for free. Some ask for a payment system where they can call for advice and be charged for it. This way they feel free to call and ask for advice without having to plea for it nor feeling guilty. But it is a minority.”
On the other hand, many equine practitioners work in remote areas that are hours away from specialists. Having the ability to call a cardiologist/ultrasound expert like Navas and consult on what type of treatment the horse needs – and whether the horse needs to be transported to a veterinary hospital hours away – is an incredibly vital tool for practitioners who are spread thin as it is. According to a practitioner who participated in a survey on telehealth’s effectiveness, telehealth works well for specialist input where there is a good trust relationship with the primary care veterinary. That is the basis for all such health.
Navas’ take-home message to veterinarians during a VMX presentation he gave on the topic was this: Telehealth is a tool that can improve animal health, education, and the profession. “We should take the opportunity.” Yet, there is potential for misuse. “We should assume the responsibility to evaluate this tool.”
The VCPR and telehealth
Having a Veterinarian-Client-Patient Relationship in place is critical whenever practicing veterinary medicine, whether you are practicing in person or remotely through telemedicine, according to The American Veterinary Medical Association. The AVMA Model Veterinary Practice Act, which many governmental bodies use as a guide when establishing or revising laws governing veterinary practice, includes the following definition of the VCPR:
A VCPR is present when all of the following requirements are met:
- The veterinarian has assumed responsibility for making clinical judgments regarding the health of the patient, and the client has agreed to follow the veterinarians’ instructions.
- The veterinarian has sufficient knowledge of the patient to initiate at least a general or preliminary diagnosis of the patient’s medical condition. This means the veterinarian is personally acquainted with the keeping and care of the patient by virtue of a timely examination of the patient by the veterinarian, or medically appropriate and timely visits by the veterinarian to the operation where the patient is managed.
- The veterinarian is readily available for follow-up evaluation or has arranged for the following: veterinary emergency coverage, and continuing care and treatment.
- The veterinarian provides oversight of treatment, compliance, and outcome.
- Patient records are maintained.
Photo 1 credit: istockphoto.com/ferrantraite
Photo 2 Caption: Specialist input via teleheath can help practioners.
Photo 2 credit: istockphoto.com/PatriciaEnciso