{"id":75645,"date":"2024-02-01T00:00:05","date_gmt":"2024-02-01T05:00:05","guid":{"rendered":"https:\/\/todaysveterinarybusiness.com\/?p=75645"},"modified":"2024-03-08T14:24:52","modified_gmt":"2024-03-08T19:24:52","slug":"telemedicine-legal-lingo-0224","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarybusiness.com\/telemedicine-legal-lingo-0224\/","title":{"rendered":"Dissecting Telemedicine"},"content":{"rendered":"

Veterinary telemedicine is poised to quickly expand exponentially. The question is whether the current regulatory scheme is adequate or illusory to ensure quality pet care and increase access to care. We will summarize the arguments for and against veterinary telemedicine, analyze the regulatory environment, and explore whether changes are needed. While readers can answer for themselves, we\u2019ll provide a frame of reference.<\/p>\n

Pros and Cons<\/strong><\/h3>\n

A newly enacted California law allows veterinarians to establish a veterinarian-client-patient relationship through telemedicine. Those in favor argued that California faced a statewide shortage of veterinarians and that a virtual house call was an excellent option for improving access to veterinary care, especially in rural locations.<\/p>\n

Opponents say the standards of acceptable veterinary care cannot possibly be met through virtual interactions because animals, unlike human patients, cannot tell a doctor what is wrong and instinctually often hide symptoms. Because telemedicine provides no direct physical contact, critics argue that the quality of care drastically falls below acceptable standards.<\/p>\n

Decrees and Directives<\/strong><\/h3>\n

The current regulatory scheme might appear more than adequate in addressing quality of care concerns. However, a critical analysis raises serious questions about the safeguards.<\/p>\n

Veterinary telemedicine regulations vary significantly from state to state. For purposes of this article, we will consider California and New Jersey. Those two states require telemedicine services to be interactive and in real time, including a video component that allows the veterinarian to observe the patient and client, and vice versa.<\/p>\n

Surprisingly, the regulations do not require an ability to electronically transmit static images, diagnostics, data or clinical information. However, since the virtual encounter must meet the same standard of care as an in-person visit, we question the standard if the technology doesn\u2019t include those capabilities.<\/p>\n

In establishing the VCPR virtually, veterinarians in California and New Jersey must introduce themselves, including any specialty or board certifications, identify the client and patient, and confirm that the client owns the animal. The veterinarian also must document the animal\u2019s physical location in the patient record.<\/p>\n

Before providing services, the veterinarian must review the patient\u2019s history and clinical records. These appear to be the only specific requirements for the veterinarian to diagnose the animal\u2019s malady.<\/p>\n

The regulations imply but don\u2019t specifically state that the veterinarian should try to fill in any gaps in the records and determine the patient\u2019s \u201cchief complaint\u201d (the reason for the encounter) to the best extent possible from the client dialogue. In addition, the regulations require a video component. Therefore, we can infer that the veterinarian must observe the patient before proceeding to the next step.<\/p>\n

At this point, after an evaluation, the veterinarian must determine whether they can provide services to the same standard of care<\/a> as when seeing a patient in a clinic. Under the strictest regulations, the determination must be made during each telemedicine encounter.<\/p>\n

As for writing a prescription, the telemedicine veterinarian may do so if it meets the standard of in-clinic care. The only exception, in some states, is that Schedule II controlled drugs require an in-person examination. The only other nuance, in some states, is that a veterinarian may not issue a prescription based on answers to an online questionnaire unless a virtual VCPR<\/a> was previously established.<\/p>\n

If telemedicine veterinarians conclude at any point that they cannot meet the standard of care, the regulations appear to require that the encounter be terminated and the client be told to seek in-clinic treatment. The strictest regulations mandate that a telemedicine veterinarian have a referral list if the virtual visit isn\u2019t appropriate, the client requests a referral or the case is an emergency.<\/p>\n

Depending on the circumstances, the standard of care might require a telemedicine veterinarian to consult with a brick-and-mortar veterinarian.<\/p>\n

After the telemedicine encounter, these four requirements come into play:<\/p>\n