How COVID-19 has changed telehealth: Updates and new laws

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It would be an understatement to say a lot has changed in the veterinary community since early 2020. The COVID-19 pandemic turned our world upside down, affecting every part of our daily lives. As veterinary professionals, we had to act quickly to keep our businesses open and continue to serve animals in our communities while ensuring everyone stayed safe.

The COVID-19 pandemic created significant challenges to how we care for our patients. Veterinary hospitals moved to curbside care, limiting or even removing the face-to-face interactions that are an important part of our ability to connect and communicate effectively with clients. As we dealt with the mandated lockdowns and travel restrictions, as well as the unpredictability associated with the virus, it was not clear initially how the veterinary industry would be affected. It was time to get creative and challenge our standard operations.

Telehealth is an overarching term, defined as using telecommunication, digital technologies, and electronic information to provide remote clinical care.¹ During the early part of the pandemic, the Centers for Disease Control and Prevention analyzed trends in human telehealth and reported a 154% increase in telehealth visits (which they also described as telemedicine visits) in the last week of March 2020 compared with the previous year. Most of these visits were related to conditions other than COVID-19.² A similar trend has been reported in the veterinary space.³ Although the word telehealth is commonly used interchangeably with telemedicine, telemedicine is a subcategory of telehealth. Telemedicine in veterinary practice is defined as the use of an electronic tool to exchange information about a patient’s health status (such as communicating with a client and observing a patient through electronic means) and requires a valid veterinarian-client-patient relationship (VCPR).⁴

Prior to the pandemic, federal law mandated that a VCPR could be established only by an in-person physical examination, and a VCPR was necessary to diagnose, prescribe medication, or otherwise treat a veterinary patient. However, during the pandemic, some states have allowed a VCPR to be established through virtual means in order to balance the provision of veterinary care with observance of social distancing and quarantine or lockdown guidelines.⁵ And the United States Food and Drug Administration (FDA) elected to temporarily suspend certain aspects of the federal VCPR requirements, particularly related to regulations governing the extra-label drug use in animals and veterinary feed directives, in efforts to widen the utilization of veterinary telemedicine during the pandemic. The FDA noted that despite these temporary suspensions in regulation, veterinarians would still need to follow VCPR requirements set by their individual states.⁶ Without a VCPR, telehealth is limited to the provision of educational content, general advice or opinion, and teletriage, which is a method of electronically assessing a patient’s condition to determine if referral to a veterinarian is warranted in times of urgency.⁴

Despite the increase in access to telemedicine, many sick pets still need to visit the veterinary hospital for diagnostics or care, and such visits are on the rise⁷ with most veterinary hospitals functioning curbside.

Telehealth has expanded, and we are communicating with clients via telephone or audiovisual means more frequently than in person. Telecommunication via audiovisual methods is particularly useful when balancing social distancing protocols with the need to demonstrate to clients how to provide care for their pets at home (eg, general health monitoring; administration of oral medications, subcutaneous fluids, or injections; provision of nutrition via feeding tubes).

As the increase in pet ownership during the pandemic overwhelmed veterinary hospitals, there has been a trend toward increasing the availability and accessibility to veterinary care. A growing number of companies have created and expanded applications to provide remote veterinary services.^8,9 These services can provide advice to pet owners who would not otherwise seek veterinary care because of financial or geographical constraints, and they also are likely to be used widely by pet owners who, in a growing digital world, want access to pet care at their fingertips.

Virtual veterinary care services show no signs of slowing down. Even as veterinary hospitals are still overwhelmed, more veterinarians intend to leave the profession,¹⁰ and staff shortages remain,¹¹ the demand for veterinary care continues to increase, and telehealth use and demand also are expected to rise.

Although the permitted provisions of establishing a VCPR without an in-person examination may have been lifted in some states during the COVID-19 pandemic, it is not yet clear whether these regulations will be temporary or whether the landscape for veterinary telemedicine will continue to evolve. The American Veterinary Medical Association (AVMA) has stated, “With the exception of emergency teletriage, including poison control services, the AVMA opposes remote consulting, including telemedicine, offered directly to the public when the intent is to diagnose and/or treat a patient in the absence of a VCPR.”¹²

Dr Lauren Harris received her DVM at Auburn University in Alabama in 2011. She completed a residency in emergency and critical care at BluePearl Specialty + Emergency Pet Hospital in 2015. In 2020, she moved into a medical operations role and serves as regional vice president of medicine for the West Region at BluePearl.

References

1. What is telehealth? US Department of Health & Human Services. Updated May 4, 2021.Accessed June 18, 2019. https://telehealth.hhs.gov/patients/understanding-telehealth/#what-is-telehealthexternal icon
2. Koonin LM, Hoots B, Tsang CA, et al. Trends in the use of telehealth during the emergence of the COVID-19 pandemic – United States, January-March 2020. MMWR Morb Mortal Wkly Rep. 2020;69(43):1595-1599. doi:10.15585/mmwr.mm6943a3
3. Barrett S. Vet telehealth surges as first US pets test positive for coronavirus. CNBC. April 23, 2020. Accessed March 17, 2021. https://www.cnbc.com/2020/04/23/vet-telehealth-surges-as-first-us-pets-test-positive-for-coronavirus.html
4. AVMA guidelines for the use of telehealth in veterinary practice: implementing connected care; 2021. American Veterinary Medical Association. Accessed March 17, 2021. https://www.avma.org/sites/default/files/2021-01/AVMA-Veterinary-Telehealth-Guidelines.pdf
5. COVID-19 state orders. American Veterinary Medical Association. Accessed March 18, 2021. https://ebusiness.avma.org/misc/stateorders.aspx
6. Coronavirus (COVID-19) update: FDA helps facilitate veterinary telemedicine during pandemic. FDA. March 24, 2020. Accessed March 17, 2021. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-helps-facilitate-veterinary-telemedicine-during-pandemic
7. Full house: people and pets in the pandemic. BluePearl Pet Hospital’s 2020 pet owner report. BluePearl Specialty + Emergency Pet Hospital. Accessed April 2, 2021. https://bluepearlvet.com/wp-content/uploads/2021/02/BluePearl-Pet-Hospitals-2020-Pet-Owner-Report-People-and-Pets-in-the-Pandemic.pdf
8. Hall C. Fuzzy lands $18M Series B for pet telemedicine platform. Crunchbase News. March 2, 2021. Accessed April 2, 2021. https://news.crunchbase.com/news/fuzzy-lands-18m-series-b-for-pet-telemedicine-platform/
9. Your personal pet health assistant. Barkibu. Accessed April 2, 2021. https://app.barkibu.com/en/
10. Arbe Montoya AI, Hazel SJ, Matthew SM, McArthur ML. Why do veterinarians leave clinical practice? A qualitative study using thematic analysis. Vet Rec. 2021;188(1):e2. doi:10.1002/vetr.2
11. Cima G. ER docs shortage turns critical. American Veterinary Medical Association. February 13, 2019. Accessed March 18, 2021. https://www.avma.org/javma-news/2019-03-01/er-docs-shortage-turns-critical
12. Telemedicine. American Veterinary Medical Association. Accessed March 17, 2021. https://www.avma.org/resources-tools/avma-policies/telemedicine