The Coronavirus Catalyst for Telemedicine

Dr. Ernie Ward
March 17, 2020

The current coronavirus outbreak is changing daily life for billions of people around the world. In addition to crashing economic markets, disrupting supplies and goods, and impeding access to basic services and entertainment, the coronavirus pandemic is forcing us to rethink how we work, what we eat, and how we interact socially. I believe the current coronavirus pandemic will serve as a catalyst for both human and veterinary telemedicine, a progression I’ve long supported. I’d like to share with you the factors influencing this movement, why every veterinary clinic should consider implementing some form of telemedicine, and what the immediate future holds for veterinary telemedicine.

Increasing Demand for Veterinary Telemedicine

Pet parents want veterinary telemedicine. Surveys indicate young pet parents are eager to try virtual veterinary visits, and many companies already offer teletriage services. As I’ve discussed many times over the past six years, the fundamental problem with these teletriage services is they can basically only tell a concerned pet parent, “Immediately see a veterinarian.” or “See your veterinarian tomorrow.” While that may ease some worried clients, most want a more meaningful interaction and deeper suite of services that they can’t get from an anonymous service. They want prescription medications when needed, they want telemedicine that isn’t limited to after-hours emergencies when their regular veterinarian is closed, they want familiar faces and the opportunity to speak with and be treated by a trusted veterinary professional they have a relationship with. In short, they want their local veterinary clinic to provide telemedicine when appropriate. 

Current Legal Challenges

The primary legal sticking point has been the Veterinary Client Patient Relationship (VCPR). In simplest terms, the traditional VCPR states that a veterinarian can’t diagnose, dispense, or prescribe a medical treatment without physically seeing the pet and client previously. During the era of steam trains and telephones, this made a lot of sense. Today’s mobile high-definition video conferencing, emerging pet wearable biometric monitors, and home delivery of drugs are beginning to challenge the old practice paradigm. Combine that with a generation of pet parents raised by video calls to friends and family, next-day deliveries, and you’ve got the elements for a new practice model. What was lacking was a catalyst. 

Economic Downturn

Veterinary clinics and nearly all businesses are experiencing dramatic downturns in transactions and revenue. Analysts expect this negative trend to last for several months, perhaps until the end of the year. No one knows because we know so little about SARS-CoV-2. Regardless, tens of millions of people are about to be introduced to online shopping, virtual services, work from home, and human telemedicine. These virtual experiences (some good and others not so good) will ignite improvements as systems and technologies are stressed. I believe the online experience is about to get a serious upgrade and that this time next year, today’s websites will begin to appear dated. 

Human Telemedicine Expanding

As pet parents interact more in the virtual world over the next few months, human telemedicine is already beginning to ramp up its offerings. Counseling, pediatrics, chronic care, medical rechecks, and nearly all non-emergent doctor visits will begin to shift toward telemedicine. The point I want my veterinary colleagues to understand is that millions of pet parents exposed to human telemedicine will quickly question why doesn’t their veterinarian offer a similar service? The fact is they can.

My Advice: Start Telemedicine Now

My advice to veterinarians during this crisis is to begin experimenting with telemedicine. You’re likely going to experience days with few appointments, and many clinics are already discouraging routine or non-emergency visits. This is an excellent opportunity to offer remote consultations and virtual minor medical checkups for existing clients. Within the current VCPR rules, most states allow that if a client and pet have visited you within the past year, you can offer telemedicine if you deem appropriate. Skin allergies, osteoarthritis, behavior consultations, many minor medical and follow-up visits can be safely and accurately conducted by videoconference. If you determine a pet’s condition is more serious or complicated and needs to be seen in your office, you can do that, too.

How Much and How to Charge?

If you’re interested in offering telemedicine to your clients, you can begin with Skype, FaceTime, Zoom, Google Hangouts, or your favorite free video conferencing service. Book the appointment either online, by email or phone and be clear about the video visit charge. I know many online teletriage services charge for a block of time, but that’s not how most veterinarians schedule exams in the real world. I recommend a flat-fee per virtual exam, with a similar fee structure based on your in-person appointment pricing. I believe you should start by charging the same fee for both virtual and in-person visits, especially if this is your first experience with telemedicine. This way, if you find it’s not a good fit for you or your clients, you won’t create a price disconnect and potentially upset some clients.

If you need to prescribe a medication, consider mailing or delivering it yourself or utilizing an online pharmacy. Carefully evaluate which service provides the best client experience while maintaining your revenue and profitability. Be cautious if an online pharmacy also offers a telehealth service. You could be inadvertently exposing your clients to a competitor.

Why Not Use Existing Services?

You may be asking why not use an existing telehealth service? My advice is that if you’re comfortable with video technology, try to retain as much control of the service as possible, particularly at first. By experimenting, you’ll be better informed about the mechanics and elements you need in a paid service in the future. Keep in mind that few, if any, of the current telehealth services provide robust integration into your practice management software or medical records.

I’m not against using a third-party provider; I want you to be informed of their limitations and potential risks. For example, if you hand over your telemedicine services to an outside provider, even if you limit it to your staff and your clinic at first, what can the company do with your client data? Sell it? Advertise to them? Are we risking potential future competition with them? These questions need to be answered before you commit to any contract. 

I expect third-party veterinary telemedicine solutions to rapidly mature during and after this health and economic crisis. I hope these suggestions will help improve existing services and result in better telemedicine options for both veterinary professionals and pet parents. I also expect large retailers and corporate veterinary practices to dramatically increase their telemedicine and telehealth presence. For independently-owned veterinary practices, this may be an excellent opportunity to further distinguish yourself from corporate-owned clinics and provide additional highly personalized services.

What about Payment?

I also recommend requesting payment immediately after the video consultation. This may run counter to what you’d expect, but think of it in terms of how you transact an examination in person. We examine, prescribe, and then charge. These are existing clients you have a current relationship with; the financial risk is no different than a client refusing to pay during checkout. PayPal, Square, Amazon Payments, Apple Pay, and Google Pay are just a few of the numerous online payment options if your current practice software, credit card, or bank doesn’t offer an online solution.

There are a few reasons I prefer this approach. The first is that if you begin an appointment and you observe the pet obviously needs immediate, in-person care, you can quickly transition from video call to in-person without the burden of refunding, transferring funds, and other financial hurdles. Another is that if you hand-off the virtual appointment to a support staff member after you’ve completed your consultation, in much the same way I do in real-life, your staff can ask the client if they need heartworm or flea preventatives, food, or other supplies. They can also schedule the next appointment, either online or in-person. I believe that virtual rechecks may prove to be the real advancement of this period, virtually eliminating many minor in-person rechecks and boosting compliance.   

It’s Early: Questions Remain

No one knows the best way to capture payment from clients yet because we haven’t evaluated widespread deployment of these services. I’m uncertain whether the current anonymous teletriage services serve as a predictive model for more traditional minor medical virtual experiences. That’s why I encourage independently-owned veterinary clinics to get ahead of this trend so our profession, and not outside investors, can help guide the evolution of telemedicine. I also predict significant technological and user experience improvements over the next year in how we pay and receive payment for virtual services.     

Scheduling Telemedicine Hours

I advise you to set aside specific hours for telemedicine, especially as you begin. Many pet parents will be working from home during this crisis, and I suspect many will transition to some form of home-office hybrid schedules afterward. This will offer opportunities to see more clients during “normal working hours” in the future and help optimize scheduling telemedicine appointments. It’s time we stopped viewing teletriage as the “new after-hours emergency service” and incorporate it into daily practice. 

Incorporate Video Consults into the Medical Record

Another best practice from human telemedicine is to record each video appointment and attach it to the patient record. Recordings of consultations may eventually be required as part of veterinary medical record-keeping, and I believe they should. Even if you can’t add it to your current PMS, save them clearly labeled on a hard drive. 

Ask Clients for Feedback

As with adding any new service, especially during challenging times such as these, be sure to ask your clients for feedback and suggestions. The key to successful implementation of any new service or product is to align your practice mission with the needs of clients. This is an extremely dynamic period, and veterinarians need to abandon previous assumptions about what may or may not work with online services. I also anticipate increasing public pressure will force medical authorities and regulatory agencies to expand the definition and scope of veterinary and human telemedicine after this pandemic resolves.      

The Choice is Clear

The choice during this current crisis is clear to me: Either try to do things differently or accept failure when the old paradigm falls. I personally believe veterinarians will have to provide telemedicine as a choice after this pandemic is over and new habits are established. Be safe out there. We’ll get through this.