Veterinary telemedicine – a state-by-state guide

May 7, 2020 | Articles

Like many practices right now, you may be looking to set up veterinary telemedicine (VTM) so you can continue to operate during the pandemic. You might also be looking to future-proof in the event you are unable to offer in-person consultations again.

Essentially there are three VTM options to consider depending on your circumstances. You can utilise a specific VTM platform which can potentially link to your clinic, you can utilise a generic video conferencing platform for communication but without any veterinary specific features or linking, OR you can consider referring clients to a VTM service run by an external provider or vet.

BUT before you boot up Zoom or sign on with a VTM service, there are a few key things to consider. Top of the list is the VTM policies of your state or territories’ Veterinary Surgeon Board. We’ve rounded up key information from several boards to help you get started.

Overall Guidance

During the COVID-19 pandemic, all Veterinary Surgeon Boards expect veterinary surgeons to use their professional judgment and risk assessment to decide whether using VTM is appropriate in particular circumstances.

Veterinary surgeons who diagnose and treat patients using remote technology such as VTM, need to: 

  • Ensure that they are registered to practice in the state or territory in which the patient is located, or that their current registration is recognised in that jurisdiction. They must adhere to the relevant legislation in both locations, if the animal resides in a different jurisdiction
  • Ensure that a bonafide veterinary surgeon/client/patient relationship has been established. However the AVA Guidelines note: “except when acting only in a tele-triage (emergency) capacity, or in an emergency health situation where human face to face contact is not advisable”
  • Make a judgement about the appropriateness of a telemedicine based consultation and in particular whether a direct physical examination is necessary
  • Assess the animal’s condition based on history, clinical signs and appropriate examination
  • Accept the ultimate responsibility for evaluating information used in assessment and treatment, irrespective of its source. This applies to information gathered by a third party who may have taken a history for the animal or examined the animal
  • Make a compliant clinical record for the examination and treatment of the animal

Be aware if you’re going the DIY route and using video conferencing platforms such as Zoom, Google Hangouts, Skype, WhatsApp, Facetime etc, that generally these platforms are not meant to be used for commercial purposes and there is often no ability to document patient history notes within the platform. The security of the platform may also not always be complete. If you are utilising an external provider be aware that they are often limited to teletriage. 

Here’s a round-up of what different Veterinary Surgeon Boards around the country recommend …

Veterinary Surgeons Board of Western Australia

“In some cases, if the COVID-19 infection becomes more widespread in Western Australia, looking after yourself and your staff will probably mean departing from best practice. We recognise this and will take the broader situation into account if any concerns are raised with the Board. In light of the risk COVID-19 poses, the Board is of the view that, if it becomes widespread in Western Australia, it would be appropriate for veterinary surgeons to also use VTM to authorise scheduled medicines where they can reasonably judge it safe to do so using patient histories and/or recent visits to the premises even without having seen the animal recently. Risk assessment and professional judgment by the veterinary surgeon in each case is still vital. 

General guidance on acting in situations where you may need to act outside the Guidelines on Telemedicine or other standards. Think about: 

  • Is this an emergency (is there a need for immediate or early veterinary treatment to save life or relieve unreasonable or unnecessary pain or distress)?
  • Can the animal be referred to someone better able to deal with the situation?
  • Discussing the situation with the client and getting their views and informed consent
  • What are the risks and are there ways to reduce them (e.g. regular and frequent follow up)?
  • Could your actions be justified to your peers?

The Board strongly recommends making a detailed record of your decision making in these circumstances.”

Read more: VSBWA website 

Veterinary Practitioners Registration Board of Victoria

“While direct physical examination of a patient by a veterinary practitioner is both central to quality veterinary care and required for establishing a bona fide veterinary-client-patient relationship, the Board takes the view that, for the period of the pandemic emergency and in order to promote social distancing, remote consultations may provide an adequate alternative to face-to-face consultations under the following constraints: 

  • The client is an existing/returning client of the veterinary clinic
  • The animal has previously been examined at/by the veterinary clinic
  • The owner is provided with options which include access to a hands-on patient consultation
  • The veterinarian conducting the consult can assure themselves that the history and subjective information provided by the owner, by telephone or video, is sufficient to implement a therapeutic plan a full veterinary medical record is maintained for each remote consultation. The record should include all information about the case, including those aspects that cannot be determined remotely; all points of discussion with the owner about treatment options; and recommendations and decisions.”

Read more: VPBVC website 

Veterinary Board of Tasmania

“VTM is not currently provided for in the Tasmanian Veterinary Standards. However, VTM may be a helpful tool to minimise the risk of exposure to COVID-19. We expect veterinarians to use their professional judgment to decide whether using VTM is appropriate in particular circumstances.

The VSS4 allows that direct examination of the animals to be treated may be omitted before supply of drugs in the following circumstances: 

a) the vet has an existing relationship through having a detailed knowledge of the client and the client’s animals. Detailed knowledge would include records of regular visits, clinical examinations, pathology/laboratory results, previous appropriate supply of drugs;

b) for the immediate relief of suffering only.

In light of the risk COVID-19 poses, we believe that, if it becomes widespread in Tasmania, it may be appropriate for veterinarians to use VTM to authorise medicines where they can reasonably judge it safe to do so using patient histories and/or recent visits to the premises even without having seen the animal recently. While this departs from the clear standard set in the Code, we consider that it may be justified in this extreme situation to protect veterinarians, their staff, and the wider public. Risk assessment and professional judgment by the veterinarian in each case is still vital. Refer to FAQ 4 regarding making these decisions.” 

Read more: VBTAS website 

Veterinary Board of the Northern Territory

“While direct physical examination of a patient by a veterinary practitioner is both central to quality veterinary care and required for establishing a bona fide veterinary-client-patient relationship, the Board takes the view that, for the period of the pandemic emergency and in order to promote social distancing, remote consultations may provide an adequate alternative to face-to-face consultations for limited scenarios e.g. people who are actually in compulsory isolation, or those who are self-isolating for a valid reason of being high risk. An example are geriatric or immunocompromised clients under the following constraints:  

  • The client is an existing/returning client of the veterinary clinic
  • The animal has previously been examined at/by the veterinary clinic
  • The owner is provided with options which include access to a hands-on patient consultation
  • The veterinarian conducting the consult can assure themselves that the history and subjective information provided by the owner, by telephone or video, is sufficient to implement a therapeutic plan
  • A full veterinary medical record is maintained for each remote consultation, which includes all information about the case including those aspects that cannot be determined remotely, and all points of discussion with the owner about treatment options, recommendations and decisions 

The decision to provide a remote consultation is the responsibility of the individual veterinary practitioner exercising their professional judgement: 

  • Have I, or my colleagues, examined and made appropriate records about this animal recently enough to allow sufficient understanding of its health and management status? 
  • Is this a condition or complaint that can be adequately assessed remotely?
  • Is a physical examination of the animal needed?
  • Is a blood test or other diagnostic test required? Can any of these samples be safely and feasibly collected and submitted by the owner/agent, without compromising animal wellbeing?
  • What is the scope of the advice I can appropriately provide, given the limited contact/inability to physically examine the animal?

It is the Board’s view that remote consultations may be used to provide general advice or health information and to undertake some general triage to determine the urgency or need for immediate referral to a veterinary practitioner for direct care. The Board reminds practitioners that they must exercise caution in offering any presumptive diagnoses, prognoses and therapeutic recommendations remotely, and must clearly communicate any limitations in doing so and alternative options to the owner. Veterinarians deciding to provide such services during the pandemic must continue to maintain professional standards as expected by their peers and the public.

If prescribing or supplying medications during a remote consultation, practitioners must ensure that, they comply with Board Guideline on supplying drugs and other medications. Requirements include ensuring that:

  1. The client is a bona fide client (or the agent of a bona fide client)
  2. The animal/property is under the care of the veterinary practitioner
  3. A therapeutic need for the drug or medication has been established (and for scheduled medications, that all reasonable steps have been taken to establish a therapeutic need)
  4. Side effects and precautions for the use of the medication have been discussed with the owner
  5. Appropriate clinical records are kept
  6. Provision is made for after-care if needed.”

Read more: VBNSW website

Veterinary Practitioners Board of New South Wales

“Telemedicine may provide an opportunity for the delivery of ongoing care to patients. The Board’s guideline, Technology-based patient consultations, sets out requirements under the Code in detail. This includes prescribing and supplying medications to patients based on a technology-based patient consultation.

If the criteria set out in the Guideline can be met by a veterinarian, telemedicine may provide a helpful way that veterinarians can continue to provide veterinary assistance to clients and patients in the event of increased social-distancing measures or business shut-downs.” 

Read more: VPBNSW website

Veterinary Surgeons Board of South Australia

“VTM is not currently provided for in any code or professional standard issued by the Veterinary Surgeons Board of South Australia. However, VTM may be a helpful tool to minimise the risk of exposure to COVID-19. Veterinary surgeons must use their professional judgement to decide whether using VTM is appropriate and necessary in particular circumstances relating to COVID-19.

The Veterinary Surgeons Board of South Australia recommends that use of VTM during the COVID-19 pandemic be limited to the following: 

  • VTM should only be conducted by a veterinary surgeon in order to diagnose a disease, injury or condition, prescribe medication or otherwise treat an animal within an existing Veterinary Surgeon-Client-Patient Relationship (VCPR), with the exception of advice given in an emergency until the patient can be seen by a veterinary surgeon
  • The veterinary surgeon should assume responsibility for making medical judgements and ensure that he or she has sufficient knowledge of the patient to make at least a differential or preliminary diagnosis of the disease, illness or condition
  • The veterinary surgeon should be readily available for follow-up evaluation, or have arranged for veterinary emergency coverage and continuing care and treatment of the patient
  • The veterinary surgeon should provide oversight of treatment, owner compliance and outcome
  • The veterinary surgeon should document the patient’s continuing care and treatment in the medical record
  • The veterinary surgeon should obtain and document the owner’s informed consent for the use of VTM
  • In the absence of a VCPR, any advice provided by the veterinary surgeon to a client through electronic means should be general and not specific to a patient, diagnosis or treatment

In light of the risk COVID-19 poses, if it becomes widespread in South Australia, it may be appropriate for veterinary surgeons to use VTM to authorise repeat medicines where they can reasonably judge it appropriate and safe to do so using patient histories and/or recent visits to the premises even without having seen the animal recently. Whilst this departs from the clear standard set out in the Code of Professional Conduct for Veterinary Surgeons, it may be justified during the COVID-19 pandemic to protect veterinary surgeons, their staff, and the wider public. Risk assessment and professional judgement by the veterinary surgeon in each case is vital”.

Read more: VSBSA website

Additional Resources 

Further guidance

by Dr Phil Tucak