What’s up with veterinary telemedicine?

Despite slick marketing that underlines the benefits of remote robotic surgery and diagnosis using smart collars, the reality of veterinary telemedicine has much more in common with a FaceTime chat. Telemedicine is nothing more than ‘medicine at a distance’, covering multiple solutions. Using modern means of communication, healthcare providers are enabled to help their patients remotely. The fundamental relationship between a vet and their client remains unchanged.

VCPR first

As in live consultations, first comes the establishment of this veterinarian-client-patient relationship (VCPR). Once this has been done, the spectrum of testing, treatment and advice that constitute veterinary medicine can begin.

Already, telemedicine is used by many vets. In fact, most practicing veterinarians spend several unpaid hours per week using telemedicine in the form of phone calls, email, fax and text messaging. But few use video calls, despite the fact that this means of communication produces better clinical information. Importantly, most current veterinary telemedicine takes place within an existing VCPR, something that dramatically limits its scope.

Seeing is knowing

The benefits of video diagnostics are many. Good information about an animal’s health can be gleaned during a high-quality video call. Skin conditions and respiratory status can be assessed remotely. In some cases, such as behavior and mobility-related issues, a telemedicine examination can yield more accurate information than an in-clinic examination. Not to mention the convenience, flexibility, and decreased stress (and risk of getting bitten!). Yet, even though a smartphone and the internet are all that’s needed, only very few vets regularly use video-based telemedicine.

Even during a lock-down period in 2020 due to COVID-19 – when strict stay-at-home regulations were widely prevalent – less than a third of vets used live video chats with clients. Of these, most used video consultations less than once a week. This, despite vets reporting that it was not difficult to use. Before the pandemic, less than 5% of veterinarians used video chats, and it is expected that the number of video calls will drop to such pre-pandemic numbers.

Unease beats usefulness

A few common explanations are usually given for a lack of interest in telemedicine. These include unclear or major legal implications of distance VCPRs. 

The inability to perform a ‘complete’ physical exam, and a lack of client demand, are also much-quoted reasons. Survey after survey of veterinary attitudes toward telemedicine finds uneasiness rather than excitement the driver to use new clinical remote diagnostics tools.

Although it promotes the use of telemedicine in general, the American Veterinary Medical Association (AVMA) has been a strong advocate for restricting telemedicine within a preexisting VCPR (that is, one established in person). This eliminates the possibility of new diagnoses or prescriptions purely through electronic means. Hotly debated, there is no evidence of harm from telemedicine VCPRs. In fact, many US states waived the physical exam requirement during the COVID-19 pandemic in order to comply with public health goals. In the Canadian province of Ontario, where telemedicine VCPRs have been legal since 2018, no widespread problems have been recognized.

Even without evidence of harm, many veterinarians consider telemedicine risky: fearing they’ll miss important examination findings and they are weary of running afoul of governing bodies. But just as phone-based services, such as pet poison hotlines, have been widespread for many years, the distinction between telemedicine and in-clinic medicine is an artificial one. Emails and phone calls from clients are triaged without being given a second thought. There is no reason why veterinarians can’t provide help from a distance.

Enormous potential

So far, video telemedicine and electronic VCPRs have remained parked in the garage, victims of poor public relations, not empirical evidence. Consumer pressure seems likely to be the cause of a shift: as tech-savvy, millennial pet owners want to prevent their animals from undergoing negative emotional experiences (for instance, a trip to the vet). This could be a great opportunity for new business in an enormous potential market: tens of millions of pets in the US go without regular veterinary visits.

In fact, most cat owners and many dog owners reported that their animal hates going to the vet, and that they would be more likely to take their pet in if it wasn’t such an impacting experience. A veterinarian offering a stress-free video examination is sure to have a market edge!

Risks and benefits

This is not to say there won’t be hurdles to overcome. Professionals’ concerns about the quality of telemedicine VCPRs are justified. In human healthcare, some evidence suggests that direct-to-consumer (DTC) telemedicine increases the risk of inappropriate antibiotic prescriptions. Already, veterinary DTC companies are taking advantage of the few states without in-person VCPR requirements, to prescribe remotely. As yet, there is no clear understanding of risks and benefits.

Veterinary telemedicine finds itself in a period of turbulence. A mix of advocacy groups, venture capitalists, shifting demographics, and modern tech are pushing from all sides, making any outcome as to how things will evolve unpredictable.

One thing is clear: nothing in telemedicine, so far, has changed the fundamental practice of medicine. Whether a VCPR is established remotely or in the clinic, the professional judgment of a veterinarian is still the foundation of good practice. Malpractice, as well as medicine, can be performed electronically. The current face-to-face system has serious flaws: serious issues regarding professional mental health, inefficiencies in practice flow, and huge gaps in access to care.

Reduce animal suffering

Why not use telemedicine to bridge these gaps? If medical care can be initiated with the touch of a button, more VCPRs can be established, and more animals can be connected to highly trained professionals. Vets swear an oath to reduce animal suffering. Yet, a trip to the vet is one of the most stressful things most pets ever experience. Using telemedicine just simply as a screening tool for unnecessary visits to the vet would spare millions of animals emotional harm. And let’s not forget the many potential benefits of telemedicine.