Telemedicine is here to stay, not gone tomorrow

For me, telemedicine has been a gradual process, not some sudden light bulb moment. It’s been something I’ve been following since 2015 when the first offerings came to market.

The current legislation is dated and was never intended to provide for recent technological advancements. The past few years have seen telemedicine providers acting as “disruptive innovators” and pushing for regulatory change.

Challenges

Every country is grappling with the challenges of the veterinary-client-patient relationship, or VCPR – how an animal is considered to be under the care of the veterinary surgeon.

The RCVS Code of Professional Conduct for Veterinary Surgeons states that it isn’t possible to form the “under care” relationship purely by remote means and that restricts prescribing, while in some other countries, VCPR regulations are more relaxed and remote prescribing is permitted.

Telemedicine requires updated regulation and, currently, the RCVS is undergoing consultation on “under care” and the provision of 24/7 care.

While that is still for the future, the COVID-19 pandemic has accelerated the telemedicine sector in a quite remarkable fashion. We have seen developments that previously would have taken several years happen in the space of the past 12 hectic months, as pet owners demanded greater access to remote health care.

Fundamentally, working within the code, where an existing “under care” relationship is not in place, remote services are limited to triage; telemedicine providers cannot provide a full consultation service and cannot diagnose, prognose or prescribe.

However, we can make triage assessments, and general, non-specific health care advice can be provided.

Fundamental

Triage is a fundamental tenet of emergency and critical care (ECC) medicine; it’s what emergency clinicians are specially trained for, and do every day, so the depth of this experience made our team well placed to respond when the pandemic began.

My team of video vet clinicians all still mainly work in emergency clinics, and that’s so important as they rapidly make the best triage decisions, ensuring patients receive the care that they need at the most appropriate location at the most appropriate time.

If you are thinking about outsourcing your own video vet service, or you were perhaps considering the idea of setting up your own remote veterinary advice service, I’d have a few key takeaways, particularly around pet owner demand and being able to service the provision.

Flexible approach

Essentially, all remote telehealth should allow pet owners to speak to an experienced – and in our case, emergency – clinician on their laptop or mobile device from the comfort of their home.

At launch, our service was exclusively out-of-hours, but immediately we could see the demand and we soon extended this to 8am to 11pm each day. We are positioned to go 24/7, if the demand is there.

As footfall has increased, we have added extra clinicians during busy times and I now have a team of 13 vets, plus several teams of vital support staff behind them. So we had to be prepared to scale up, and quickly.

For those who have taken on the Video Vets Now roles, it really works for them, providing excellent work-life balance.

Most in my team have young children, and being able to work from home, as well as the clinic, has been a real help, especially with home-schooling recently.

A couple of staff have spent time quarantined abroad, unable to return to the UK. They have been able to expand their career portfolio while staying within the company and maintain their ECC skills. With staffing and technology solutions, which can be complicated, it has been a big undertaking, as is managing referral to daytime practices.

All telemedicine providers have to decide where to refer cases, if appropriate.

Hub and spoke

Due to the structure of our hub-and-spoke set-up, we can easily refer urgent cases. We have our own network of OOH emergency clinics and, as part of the IVC Evidensia group, we have the support of its practices for unregistered clients during daytime business hours.

But, of course, we also have the important and extensive relationship with our 1,400 independent and corporate partner practices. We are absolutely committed to working with them to return their registered clients during the daytime, if that is clinically appropriate.

So, what are the potential benefits to our sector from this growing trend towards using telemedicine?

Roughly one-third of our video vet calls are referred to a clinical consultation, meaning two-thirds of those cases don’t need to be seen by a vet. I know this might seem an unsettling prospect for practices, but importantly, as cases are being triaged remotely, we’ve found it frees up clinical staff for genuine emergencies.

It should also mean less waiting time for clients. As the pet has already been triaged by a qualified emergency vet, there’s less time spent on triage when it arrives at the clinic.

Another option

There is no prospect of online consultations taking over from face-to-face consults. Pets that require veterinary treatment will still need to be seen at a clinic or hospital. But they will only have to go when they need to go. Without a video vet service in place, many of those clients would have no other option than to attend for a full consultation at one of our clinics. So, clients save money too, allowing them to save their budget to spend at their daytime practices.

Fundamentally, it offers pet owners easy, and often immediate, access to an experienced veterinarian without having to undergo a stressful trip in the car or on public transport.

Of course, you are only ever going to have a successful service if it’s something people are happy to use.

Until a few years ago there was no option of telemedicine in human medicine, but as those became established it was common sense that these services would be developed for veterinary patients, too.

The changes in so many people’s lives in the past year have definitely helped to drive the boom in telemedicine.

It was novel at first, but even if clients haven’t had a medical consultation themselves, many have become used to video-conferencing software, like Zoom, for work or leisure.

Despite that, the vets have had to manage their expectations as to what can be achieved through remote examination of pets.

Common challenges

Challenges with lighting, quality of cameras, device idiosyncrasies and bandwidth can occur. Clients can provide images and videos, asynchronously, to supplement the consultation, which can help.

However, regardless of how simple the software is to use, much depends on how tech-savvy clients are, so vets have to err on the side of caution during triage.

Strange as it might sound, it also depends on whether the pet is actually present.

The team records its consultations, which we review for training and quality assurance, and it’s surprising how many start without the pet. You may expect that clients, having booked an appointment, will be ready to go with the pet sitting beside them.

But a majority begin solely with the client, who then has to go to try to find the pet in another room or coax it out from under a bed.

However, there is no doubt that, in our experience, the video vet service has been warmly welcomed by pet owners.

I think one main outstanding controversy still remains, and that is a misunderstanding among some clients with regards to prescribing.

Despite a temporary relaxation in the regulations regarding remote prescribing during the pandemic, the obligation to ensure safe and ethical care is an overriding principle.

Veterinary surgeons are required to ensure they can provide 24/7 aftercare to pets that have medication prescribed and, even though Vets Now can do this through our network of pet emergency clinics, Video Vets Now does not prescribe medication, and has not sought to offer that provision during the temporary relaxation.

The other significant challenge for practice managers to be aware of is that some clients request a consultation for conditions that are not appropriate; breathing difficulties, for example.

Obviously, we do signpost clients away from the video vet service and towards a face-to-face consultation, where it is obvious that is what is required.

Overall, though, these challenges can be mitigated and massive scope exists for increased use of telemedicine within the veterinary profession.

It has become something that clients have grown to expect, and several companies can now offer this service.

So, as a consequence, we all need to be prepared to see its use grow even more during 2021. And, fundamentally, this technological transformation that our sector is experiencing can only be good for pets, and for our professions.