What Happens If Veterinary Medicine Doesn’t Keep Up With Human Medicine During Coronavirus Emergency?

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The week of March 15-21 saw America wake up in flashing red lights to the potential scale of the COVID-19 crisis, and take unprecedented steps to cope, contain and, hopefully, turn the tide. Veterinary medicine engaged in policy and operational debates, and decisions, at all levels. The profession and industry focused on ensuring that governmental designations of “essential services or business” include veterinary clinics, and to preserving supply chains for personal protective equipment (PPE).

Now comes the really hard part on two fronts, as COVID-19 continues to spread at a rapid pace and human healthcare faces the threat of running out of supplies and beds, and perhaps healthcare providers. 

  1. Can alternative sources of PPE be provided for veterinary procedures when and if governments declare that all available PPE (traditional types) be made available to human hospitals and clinics? Ultimately we won’t win an argument with policymakers that veterinary needs trump human health needs. In fact, the risk we run (already faced but overcome in one state on March 20) is that Governors re-consider veterinary medicine’s designation as an “essential service” if we claim that we cannot operate our clinics without existing sources of PPE. We must be able to assure decision-makers that (a) veterinarians do many things for pets that do not require all manners of PPE, and (b) we have other sources of protective gear to enable us to perform important procedures.
  1. Human medicine is shouting from the mountaintops for all practitioners and patients to hear that telemedicine is and will remain available. Useful care can be provided through telemedicine tools, and we avoid requiring people to travel to clinics or hospitals and risk exposure to COVID-19 and exacerbating the situation. West Virginia, Oregon and Texas veterinary medical boards, and the Rhode Island Department of Health, have stepped up and encouraged veterinarians to use telemedicine for the same reasons (Oregon, West Virginia and Rhode Island even temporarily waived rules prohibiting the creation of a client relationship (VCPR) through telemedicine). But a number of state boards, who will go unmentioned, along with Veterinary Medical Associations, have taken upon themselves to declare in social media and websites that veterinarians must be reminded that they cannot create a VCPR, even in these unprecedented and complex emergency circumstances, through telemedicine. Which means that veterinarians cannot treat a pet or help a pet owner over the phone, or through texts, if they haven’t seen the pet. Was it really necessary to warn trained, licensed professionals in the middle of a complex crisis, unfolding by the hour?

How do YOU think the public reacts to this stark contrast between the emergency response of human medicine and veterinary medicine? Do people really believe that America’s pets are better off with pet owners receiving no medical advice in the midst of the COVID-19 emergency because they cannot travel to a clinic, or are afraid to? All state veterinary medical boards need to follow the lead of West Virginia, Oregon and Rhode Island, waive existing VCPR requirements, and do so quickly.

7 Comments

  1. Richard Ward on March 22, 2020 at 10:49 pm

    Mark,
    Thanks for raising this important issue. We’re glad to learn some states are loosening or waiving VCPR to allow better access to medical care for animals and their owners. In addition to the states you mention, we’ve been advised the California Governor’s “state of emergency” declaration waived some VCPR regulations.
    The good news is the Independent Veterinary Network LLC has advanced the availability of the VIP-1 virtual veterinary platform. This innovative system provides text and video access that enables clients to easily connect to their veterinarians. In the past week, we’ve installed these critical remote services in practices in several states. IVN waives set up fees and the first three months of IVN Membership to help veterinarians maintain practice operations. More information is at http://www.IndependentVetNet.com or an email to rward@IndependentVetNet.com.
    The VIP-1 system allows social distancing without risking COVID-19 exposure to clients and veterinary professionals and staff. DVMs who are away from their office for family care or quarantine can continue to serve patients. The telehealth capability provides a triage capability before a need for physical care is needed.
    DVMs provide the service using their brand identity, not IVN’s and set their own fees for services. Each practice determines the hours they are available, up to 24/7. Installation can be done in about 24 hours. IVN receives a 5% fee to cover technology and administrative costs.

    Richard Ward. Chief Operations Officer
    Independent Veterinary Network LLC
    Kansas City

  2. Elise Lacher on March 22, 2020 at 10:52 pm

    To my mind it sends a very bad message to pet owners that our governing bodies are so rule bound that even in an emergency situation the likes of which we have never seen, they can’t waive the rules to accommodate owners and pets. Makes you wonder why they chose the profession in the first place. I would think a better response would be along the lines of waiving any liability to the vets somehow if an adverse affect as a result of using telemedicine. Even the government, both federal and some states, are relaxing rules during this time. (The IRS relaxed the due date for paying your taxes. If they can do it, can’t we?)

  3. Bruce Truman on March 23, 2020 at 2:27 pm

    Mark: Thank you for posting this and for pushing. Veterinarians can still see patients – just remotely. At BabeBark the platform is now free for practices to use to facilitate remote care. For their clients we are providing free, unlimited 24/7 calls to our veterinary help hotline powered by whiskerDocs. Details of the call are then provided to the veterinary practice. This can help practices that have to close or are short-staffed and want to use our service to triage.

  4. Deb Leon on March 23, 2020 at 4:27 pm

    I think it’s gotten to the point that those who say they are protecting the profession by holding positions against telemedicine, including allowing cross-state practice and the establishment of VCPR by virtual means, run the risk of appearing just plain self-serving. Frankly, if we were to tell our callers the truth, that veterinary boards are standing in the way of the care of their pet, I believe pet parents would feel that the true motive was greed. WE ARE IN A TIME OF CRISIS and these staunchly conservative positions are creating unnecessary risks and potential health issues for everyone involved. Concerns about pets carrying their virus on their fur is also leading to veterinary clinics needing more PPE, to Mark’s point. That is already a serious problem.
    Our veterinary team is distraught by the limitations imposed and I frankly am having a hard time telling licensed veterinarians that they can not help. For example, not being able to tell a pet owner that they can give a Benadryl for a common, topical allergic reaction (example: spider bite), is ridiculous. Or how about giving Famotidine for a pet with nausea or vomiting? We have protocols that will absolutely recommend folks to go to their local veterinarian when needed, but when we hear that that is not an option for them, I certainly would hope that the state boards will allow our licensed veterinary team to make those common sense recommendations. We follow up on every single interaction, whether chat or email, to make sure that the pet is doing well. A well-executed, protocol driven telemedicine service can help in times like this. For goodness sakes, it’s time.

  5. Daryl P. Mensik DVM MBA on March 23, 2020 at 4:53 pm

    I would be curious if you and your organization could disclose if you have any affiliation with or are paid by any group (public or private) that is advocating the use of telemedicine in a veterinary context/setting. I believe that this disclosure is needed to really assess your assertions as unbiased or is there any sway in wanting to use this crisis to push an agenda forward. I realize that this situation is unprecedented and that drastic times call for drastic measures. However, I am just concerned that once this is an option, then we cannot put the toothpaste back in the tube and it will forever change the practice of veterinary medicine versus just being temporarily used as needed during a crisis. Just my thoughts.

  6. mark cushing on March 23, 2020 at 6:54 pm

    You can access our current and past client list at http://www.animalpolicygroup.com. My current blog, like my articles and speeches, is not on behalf of clients and I don’t speak for my clients on policy issues unless they request that I do so. Unprecedented emergencies demand extraordinary responses, and the issue for me is not putting toothpaste back in the tube. We’ll deal with normal once we see it again.

  7. Audrey J Wystrach DVM CEO One Vet on March 23, 2020 at 7:24 pm

    Mark thank you for recognizing and standing up for what the Veterinary profession needs to be relevant to the changing ecosystem around us. I have worked with you for years and respect your opinion and your passion for and dedication to preserving and improving this great profession. I am on your team and support you 100%.

    I have been utilizing telehealth throughout my 25 years of practice. I have worked as a licensed practitioner and business owner. My practice experiences have included rural mixed animal farm call/hospital practice, performance equine practice, house call practice to corporate practice and most recently building a de novo hospital group. More accessible, convenient healthcare for patients is the driving force behind my inclusion of telemedicine in daily practice. I originally utilized telemedicine to address a rural pet population with a very large geographic territory. Telemedicine has the power not only to break down typical geographical barriers to care access, but to make the entire petcare delivery model more convenient to pet parents.

    Most recently I created a virtual care model surrounding a four wall veterinary care center. These denovo hospitals were focussed on the tenants of hospitality, convenience, transparency and connectivity of pet parents and healthcare teams. This was a great proving ground for a connected care model. Increasing revenue to hospitals, improving clinical outcomes, engaging and empowering medical teams and pet parents, enhancing customer experiences, increased access with extended hours, advice and helpline as enhancements to client retention…just to name a few benefits.

    My advice to those considering adoption of connected care in practice.
    -Have Clearly Defined Goals. … SOPs
    -Involve your Staff -pick the right team members to play.
    -Find the Right Technology Partner. …
    -Decide How Telemedicine Will Be Utilized in Your Practice. …Hours, teams etc.
    -Market the Service to your existing clients …it is a learning curve- education is key for teams and customers
    -Ask for Feedback from your medical teams and pet parents …this is one of the keys to a successful program
    -Measure Success Against Your Goals

    This is what I know and what I believe to have learned in my practice journey that has included connected care for decades!

    -Better quality care: Telemedicine improves quality of care by making it easier for healthcare teams to follow-up with patients. Additionally giving us access to monitor patients remotely, and respond to concerns when called upon.
    -Better access, more consistent engagement: The virtual visit makes it easy for veterinarians to consult with pet parents. Ease of access leads to more consistent engagement, meaning more “more questions asked and answered, stronger doctor-patient relationship, increased opportunities for engagement and clients who feel empowered to manage their pets care.
    -Patient demand and satisfaction: Today’s clients live an increasingly connected life and expect a different kind of care experience. Telemedicine engages patients by increasing the connectivity with their healthcare teams.
    -There is tremendous resistance to change. There are some veterinary care organizations are eager to adopt technology, there is tremendous lag in bringing together the many pieces that can enable true connectivity and continuity of care. Governing bodies, leadership and a consolidated effort of the majority of practitioners have got to come together to create a rapidly changing ecosystem. We do not have the luxury of time on our sides. Things need to change. We have been talking about this for long enough. Now we need to act!
    -Patient acceptance of telehealth is also a key factor, and challenge, in the success of telehealth. Healthcare teams need to build out defined processes so they can have trust around ensuring the delivery of best medicine. It is equally important to focus on ensuring a positive client experience.This is rapidly changing as the human care models are not only rapidly changing laws but emphatically encouraging this as first line of communication.
    -Training and Adoption to promote widespread usage and adoption of telehealth solutions is a big hurdle for veterinary organizations. Whether an organization is attempting to indoctrinate veterinarians and nurses who are technology-shy, or appeal to recent vet school grads who insist on using iPads, creating usable telehealth across veterinary care systems is a challenge. A large part of my telehealth strategy included thinking through a plan to evangelize telehealth, train users, and create flexibility in the usage of the solution.
    -Telehealth providers and building a comprehensive solution that serves providers at every endpoint. When selecting a telehealth partner, organizations should look for one that is able to handle scheduling of healthcare teams, patients, payment functionality and accurate, readily available and integrated medical record transfer.
    -Do not repeat mistakes.. Relying on lessons learned ..Human healthcare is faced with a variety of limitations and barriers. Matters like reimbursement policies, privacy protection, and healthcare laws. Still, even larger than any other concern has to be cybersecurity and HIPAA compliance. The veterinary profession needs to follow guidelines, comply with individual state law and observe best practices. We must look to what human medicine has learned and apply this to building out robust and reliable processes. If they can do this so can we!
    -Careful consideration of case selection for treatment and a keen understanding of triage algorithms. I believe that careful selection of signalment and cases is imperative to build a successful program. There are great uses for virtual visits in the categories of nutrition, behaviour, dermatology, preventative care, puppy and kitten care, triage for urgent concerns. Being mindful throughout the process that this is ultimately a complimentary service to four wall veterinary care centers. In my experience, there are only about 30 % of cases that can be resolved through digital only care. The ability to supplement virtual care with traditional hospital visits and in person medical triage is critical.
    -Veterinarians and leadership organizations need to be aware of the unique challenges that are facing our profession and the people and pets that we are tasked with caring for. The principal of do no harm is what we should be utilized as guidance. We are leaving many people very vulnerable in this current state. The long term repercussions of pet care without veterinary guidance could be bigger than anything we might imagine. The time is right for telehealth. Telehealth can enable organizations to provide expanded care to clients while operating more efficiently and cost-effectively, plus generate potential new sources of revenue. As veterinary care organizations begin to consider adopting telehealth, it is important to think strategically. Implementing telehealth is about more than just wanting to be part of a trend. Designing a customized system that can work for your organization over the long term requires a deep understanding of capabilities, teams, integrations and supportive telehealth partners. One must understand the business challenges you face and determine if you can implement a cost-efficient, highly reliable and scalable telehealth solution that creates positive and productive experiences for healthcare teams and their customers.

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