Some “how to” guidance on using veterinary telemedicine
9 April 2020
Here is some guidance for veterinarians looking to use telemedicine during the lockdown who haven’t used it before. See also our COVID-19 statement on veterinary medicines and authorising, which includes information on using telemedicine.
When we talk about veterinary telemedicine (VTM), we mean the use of technology, such as phone, email or videoconferencing to provide veterinary care without being physically present with the animal or owner. This includes diagnosis and treatment.
VTM is a broad term. It is helpful to think about some of the different types of VTM:
- Transmission of stored health information. For example, a client sending photos or video to their veterinarian or a veterinarian forwarding records to a specialist.
- Real-time transmission of health information. For example, a video or telephone consult with a client.
- Mobile-health – using mobile devices to help deliver care. For example, text reminders sent to clients.
- Remote monitoring. For example, using wearables or live video footage to monitor a patient.
For present purposes, we are focussing on the first 2 types above but it’s helpful to understand that telemedicine can mean a whole range of things to different people.
At its simplest, telemedicine can involve doing telephone triage with clients, something almost all veterinarians do already. From there, having clients send you photos or videos is not a big jump and, from there, having a video call with a client is a natural progression.
There are dedicated telemedicine software solutions available. We don’t discuss them any further in this article but the same principles apply.
Privacy and security
Veterinarians have a duty to protect their clients’ personal information and telemedicine doesn’t change that. Here are some practical things to think about when setting up a telemedicine system:
Is the programme you’re using private?
You want to limit who can see the information that’s being transmitted – normally to just the veterinarian and the client.
Ideally, you should use a programme that offers end-to-end encryption which helps prevent others being able to see or intercept your conversation. Some examples of apps that support end-to-end encryption are WhatsApp, Apple’s FaceTime and iMessage, and Signal. These apps are preferable to normal text messaging, which isn’t end-to-end encrypted and is less secure. These are just a few of many options and you should do your own research to help decide which will work best for you (there are also dedicated telemedicine programmes which you may want to look into). Part of that exercise will be deciding which app strikes the best balance between privacy and security and ease of access and use for clients.
If you’re using email to receive or send information like images or videos, consider researching and using email encryption.
We strongly advise against using public platforms, such as Facebook groups and pages, to conduct any VTM. They are useful ways to advertise your services and connect with clients but they are not private.
Device security
You need to ensure that other people can’t access client information (clinical history, photos, recorded videos, chat logs, etc) without your permission. This means keeping the device you use for VTM secure. At a minimum it should have a password or passcode known only to you and you should consider doing more – see CERTNZ’s cybersecurity tips here.
Back ups
Is your data backed up? Computers and smart devices can be damaged or lost and sometimes they just break. It’s best to have your data backed up somewhere secure before that happens.
Note that we do not require you to keep videos, photos or recordings of digital consults. The Code only requires you to keep records and, as with physical consults, this will normally be the clinical notes you make. If you do choose to keep videos, photos or recordings, they should be kept securely, and you must make sure the client understands and consents to you keeping them. This might be something to put in your standard consent forms.
Informed consent
Make sure your clients understand the shortcomings of telemedicine before you use it with them. They need to understand that it is not a perfect substitute for physical examination and accept the risks that come with that. That said, there may be no other alternative for the client at present if the care they need is not essential and you may have to explain that to them.
Decision making
Even with the best technology, VTM is not a perfect substitute for physical examination in many cases. During lockdown, we need to make some sacrifices to help prevent the spread of COVID-19 and this includes using VTM in the place of physical examination, where possible, even if that means you don’t have as much information as you would like. However, that does not prevent you deciding a physical examination is needed – if it has to happen right away, you can arrange that with the client and, if it doesn’t, it can wait till after lockdown.
Record keeping
The same requirements for record keeping apply to VTM – records must be clear and accurate and have enough detail that another veterinarian could take over at any time. When authorising restricted veterinary medicines in production animals, the records should also document information provided to clients to prevent any residues occurring from any animal treated – veterinarians should refer to the ACVM Notice: Requirements for Authorising Veterinarians. In the context of VTM, records should include documenting informed consent and the veterinarian’s thinking around the suitability of VTM for the case.
Location and emergency care
This article focusses on using VTM for local clients during lockdown to help reduce physical contact. This means veterinarians will be able to provide face-to-face emergency care if needed. Veterinarians considering providing VTM to clients who are geographically remote from them will need to put considerably more thought into it and ensure that they have robust measures in place to provide emergency care to those clients – VTM is not enough on its own.
Charging
VCNZ does not have any requirements around whether or how much to charge clients for VTM services. That is a decision for individual veterinary businesses.
An example – how VTM might be used in practice
Practice A has never used VTM before except for telephone triage. During lockdown, they decide to offer video-calling consults for patient/animal care and to keep in touch with clients. They decide on the following system:
- When clients call, a veterinary nurse triages and, for suitable cases, offers the client a video consult. The nurse explains how it will work and that the veterinarian will start with a video call but may need them to come in for a consult if they decide they can’t help by video.
- If the client accepts, the nurse books them an appointment and emails them instructions, including how to download and install Signal and link it to their cell phone number (Signal is a free, secure and private messaging and calling app that is used by many international organisations and governments but it is only one of many options).
- The veterinarian uses Signal to video call the client at the arranged time. They start with a pre-prepared script on how the video-consult will work and they get the client’s consent to continue.