Telehealth has taken hold in many small-animal private practices, but what about the equine field? As Piavita offers a remote monitoring solution for equine vets, we’re no stranger to the promise of telehealth in equine medicine. But as the equine industry is historically slow in adopting new technologies and adapting to changes in methodology, we wanted to introduce the topic of telehealth and discuss the applications and limitations for equine veterinarians.
WHAT IS TELEHEALTH?
According to a 2018 white paper by the American Association of Equine Practitioners (AAEP), “Telehealth, by definition, encompasses all uses of technology designed to remotely deliver health information or education. Telemedicine is an exchange from one site to another via electronic communication to improve a patient’s healthcare. In practice, telehealth is a collaborative tool for equine veterinarians to enhance diagnostic testing, consultation with experts, patient treatment and monitoring, as well as owner communication.”
TELEHEALTH IN PRACTICE
In practice, telehealth encompasses five categories:
Teleconsulting is when two vets or a vet and a specialist consult on a case.
Teletriage or Teleadvice is when the vet provides health information, opinion, guidance or recommendations to clients concerning, but not specific to, the patient’s health, illness or injury.
Teleprescribing is the process of “writing” digital, paper-free prescriptions. When prescribing digitally, it’s important that the vet continues to follow all state and federal laws and regulations.
Telemedicine is between the vet and the client and requires a Veterinary-Client-Patient Relationship (VCPR) agreement.
Telemonitoring is remote monitoring of the patient’s condition while the vet is in a different location than the patient.
Telehealth and virtual care are extensions of veterinary care and can serve to add value to equine veterinary practices. And while the limitations seem few, equine vets should practice carefully within the parameters of state and federal law. This means only providing services under a veterinary-client-patient relationship (VCPR).
According to an article in the Journal of American Veterinary Medical Association (JAVMA), “Telemedicine should only be conducted within an existing veterinary-client-patient relationship, except for advice given in an emergency until a patient can be seen by a veterinarian, according to state and federal law.”
WHAT EXACTLY IS A VCPR?
According to the American Veterinary Medical Association (AVMA), the VCPR is the “basis for interaction among veterinarians, their clients, and their patients and is critical to the health of animals.” If a VCPR is properly established, the following are true:
- The veterinarian has assumed the 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 medical condition of the patient. This means that 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.
LIMITATIONS & RISKS
All vets are expected to adhere to the ethical code of conduct under the AVMA’s Principles of Veterinary Medical Ethics. And a big piece of the ethical puzzle is the VCPR. But with the development of new methods and technologies for veterinary medicine, vets must take special care to continue to operate within the boundaries of state and federal laws.
In the absence of a VCPR, offering “advice only” can be risky and limitations vary by state, making legislation a challenge.
The AVMA defines advice as “providing of any health information, opinion, guidance or recommendation concerning prudent future actions that are not specific to a particular patient’s health, illness or injury.” This advice is meant to be general, and not to give information that is considered diagnostic, prognostic, or treatment-oriented.
However, the argument exists that general, non-patient-specific information is of little use to clients today. Veterinary medical information online abounds. Although finding misinformation is in itself a risk, clients are quick to check a clinic website before calling the vet. Ultimately, the presence of the internet in modern medicine—both human and animal—has outpaced the ability of regulators, legislators and the insurance industry to adjust and adapt.
Location, location, location
Regulating teleadvice is challenging due to the differing rules among states. For example, in Minnesota, giving advice is considered the practice of veterinary medicine. In addition, when providing telehealth services, the location of the horse being treated is very important. Is the veterinarian providing the advice licensed in a different state than where the horse is located? If so, not only is the vet in this case operating outside of a VCPR, but may also be practicing veterinary medicine without a license.
Ultimately, the AAEP states that “the equine practitioner is responsible for making decisions regarding the use of telehealth tools for clients, and for upholding the standard of care within applicable state regulations.
TELEHEALTH APPLICATIONS FOR EQUINE VETS
There are many applications of telehealth in use in veterinary medicine today, but most are asynchronous, meaning they’re not done in real time. But with the presence of digital technologies and real-time communication in clients’ personal and professional lives, they’re coming to expect that their vets offer more synchronous and remote telehealth services.
Asynchronous telehealth in equine medicine is largely used to diagnose health issues, which requires digital communication, data storage, and file sharing. Vets can communicate with or have information reviewed by colleagues, specialists, clients, trainers, and farriers. Common uses are for radiology, dermatology, and pathology.
Synchronous telehealth in equine medicine is interactive and done in real time. This means the vet uses video or audio conferencing to view and discuss patient health with the client and/or specialist. An example of this in practice is dynamic videoendoscopy of the upper airway of exercising horses when images are seen in real time. This real-time communication and information sharing speeds up diagnosis, allowing patients to be treated faster. It also shortens the entire process for the vet and client, reducing stress and potentially saving costs along the way.
Another type of synchronous telehealth in equine medicine—one that’s growing in demand—is remote monitoring. Remote monitoring means collecting health data using easy-to-use devices and connected systems. The vet can access data such as vital sign measurements and other health parameters in real time while in a different location than the horse. Video surveillance is also used in hospitals and clinics to monitor patient activity and signs of distress.
Remote monitoring serves the equine veterinary community in a host of ways. It increases safety, saves time, adds value, and aids vets in their diagnostic and treatment decisions. As concluded by the AAEP, “Telehealth and telemedicine expand the availability and performance of high quality equine veterinary care by encompassing a wide variety of technologies and methodologies to deliver virtual medical, health and education services.”
BENEFITS OF TELEHEALTH
The benefits of telehealth in equine medicine abound. We asked our lead veterinarian consultant, Sara Perestrelo, DVM, to share her thoughts on the benefits of telehealth for vets, clients and patients.
“Telehealth services offer a lot of benefits for vets, clients and patients. With the support of a telehealth service/system, vets can safely have concurrent access to different parameters that are related to the horse’s overall general health, which also saves a lot of stress for the animal.”
“Horse owners can also play an active role when it comes to telehealth services, since they can be more involved in their horse’s overall health. Especially when taking care of a horse remotely, it’s definitely useful to have a monitoring option for horses that are in recovery or in an unstable state. [Using telehealth services], clients can easily track their horse’s health no matter where they are and call their vet immediately if they notice a change in the horses’s state of health.”
“For patients, the advantages come indirectly. [The horses] don’t need to be handled so often for health check-ups and they can be assisted faster when in need.”
As concluded by the AAEP, “Telehealth and telemedicine expand the availability and performance of high quality equine veterinary care by encompassing a wide variety of technologies and methodologies to deliver virtual medical, health and education services.”
While telehealth in equine medicine is already in practice, advancements are being made every day to help vets with their daily routines, increase service offerings, and make work safer for practitioners and horses alike. Piavita is proud to be part of the movement to digitize equine veterinary care, and we support telehealth when done ethically and responsibly. If you have questions about telehealth, visit the AVMA’s Telehealth Resource Center.