Telemedicine & Its Impact on Veterinary Medicine

• is the overarching term that encompasses all uses of technology geared to the remote delivery of health information or education. In other words, telehealth could be used to describe everything from websites to activity trackers for pets. If a veterinary team updates clients about their pets’ health by using the phone, emailing, or sending and receiving text messages, images, and videos, they are using telehealth tools.  
• is a subcategory of telehealth in which technology is used to exchange medical information about a patient’s clinical health status from one site to another. The most obvious uses for telemedicine are for diagnosing cases and prescribing medications (eg, a client‒veterinarian video call that replaces a physical visit to the practice).

^a Definitions adapted from the AVMA Practice Advisory Panel’s final report on telemedicine, published January 2017. 

• is the overarching term that encompasses all uses of technology geared to the remote delivery of health information or education. In other words, telehealth could be used to describe everything from websites to activity trackers for pets. If a veterinary team updates clients about their pets’ health by using the phone, emailing, or sending and receiving text messages, images, and videos, they are using telehealth tools.  
• is a subcategory of telehealth in which technology is used to exchange medical information about a patient’s clinical health status from one site to another. The most obvious uses for telemedicine are for diagnosing cases and prescribing medications (eg, a client‒veterinarian video call that replaces a physical visit to the practice).

^a Definitions adapted from the AVMA Practice Advisory Panel’s final report on telemedicine, published January 2017. 

The AVMA is creating a toolkit that practitioners can use to further incorporate telemedicine tools into their existing practices. The toolkit will include potential applications, various service model descriptions, case studies, legal and regulatory considerations, equipment resources, and monetization guidelines (ie, many smartphone apps will allow practitioners to charge for their time and services). Further details will be released when the full toolkit is rolled out at the July 2018 AVMA convention in Denver. 

The AVMA Policy on Telemedicine was developed after 2 years of intensive study and input from members and stakeholders. The policy provides a balance between ensuring access to the convenience and benefits afforded by this tool and promoting the responsible provision of high-quality veterinary care. The policy also reinforces that telemedicine should only be conducted within an existing VCPR. The AVMA recognizes that future policies will be evaluated and informed by evidence-based research on the impact of telemedicine with regard to access to care and patient safety. 

The AVMA recognizes the need for emergency teletriage services (eg, poison control) but is otherwise opposed to remote consulting offered directly to the public when the intent is to diagnose and/or treat a patient outside an established VCPR. A veterinarian who has an established VCPR, however, has the professional discretion to consult with specialists or other experts, and the consultant should not be required to hold a license in the state where the veterinarian with the VCPR practices or where the patient resides (ie, the veterinarian with the VCPR should be able to have a radiologist in another state read a patient’s radiographs). 

Telemedicine guidelines should be harmonized across the nation and strongly enforced to protect patient and public safety. The AVMA supports regulatory efforts to clarify where the actual practice of veterinary medicine occurs when offered through telemedicine modalities, who has regulatory enforcement and disciplinary authority, and what remedies are available in case of patient harm. 

Eligibility to provide telemedicine services should be restricted to those people who are legally authorized to practice veterinary medicine in that state, and the credentials of all advice givers, as well as any disclaimers, should be unambiguous and clearly displayed. Clients should be aware of the advice giver’s identity, location, licensure status, and potential privacy and security issues with electronic communications. 

Finally, the AVMA policy states that the legal accountability, liability, and responsibility of the practicing veterinarian should be in both the state where the patient is located and the state where the veterinarian is located.