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Do you feel like you should start offering telemedicine in your practice? You are not alone. But are you already overwhelmed by the stress of your current workflow? The sheer volume of telemedicine choices? You are in fine company indeed.
Just as when you faced your first abdominal surgery, poised with scalpel in hand and heart in throat, you know the only way to complete this task is to make the first cut. In listening to the concerns of my colleagues, I’ve determined three principle hurdles stand in the way of us “making the first cut” for telemedicine.
The beauty is, these challenges are no different from the ones we ask pet owners to overcome every time they say yes to a surgery we recommend. Let me convince you that you can say yes, too.
The Big Three
Our clients want their pet’s surgery to be:
Noble desires all—and an accurate reflection of what we want deep down in the realm of telemedicine. Let’s address these points one at a time as we stand at the crossroads of a decision that may change the trajectory of veterinary medicine forever.
In the current COVID-19 landscape, we want absolute assurance that our licenses and our livelihoods are safe if we examine, diagnose, and treat our patients through electronic means. I don’t know about you, but for the last twenty years of my career, the Veterinarian-Patient-Client Relationship slumbered undisturbed in my closet of “Vaguely Remembered Things From Vet School.” I figured, if I didn’t do anything crazy, I didn’t have to worry about this dusty little snoozer. But the world pandemic has wrenched that closet door open and thrust the poor thing, staggering and blinking, into a very unnatural spotlight.
Executive orders by governors, announcements by the FDA, and revised or doubled-down language by state medical boards have stretched and bent the VCPR fifty different ways. It is no wonder we hesitate to stride down the path of telemedicine. But as with all problems that need to be solved, knowledge is power.
Veterinary Practice Act and VMA language ranges from allowing VCPRs to be established for new clients and new problems solely through electronic means (Ontario VMA guidelines from our friends in the Great White North) to rigid VCPRs allowing only current problems to be managed—short of dispensing new medications—through telemedicine.
Online resources abound, the most important of which is your state veterinary practice act. This document trumps all federal COVID-related VCPR statutes because your state medical board holds the fate of your license in its hands. Some states use the AVMA’s definition of the VCPR. Many have implemented their own language. Your VMA can help you understand the language and terms of the VCPR in your state.
Realize that your state’s VCPR definition may be a moving target right now. Stay abreast of changes by checking announcements on your state VMA’s website frequently. One of the most succinct resources I’ve found for VCPR status state-by state is the AVMA’s List of State VCPR Laws. The AVMA also lists several useful links on this page, including a Spreadsheet of COVID-19’s State Orders. In addition, the Veterinary Telemedicine Community Facebook group and the Veterinary Virtual Care Association are helping practitioners collaborate and pool resources to know where they stand.
The Pain Scale
My dog just had a TPLO. Do you know what my main concern for her was? It wasn’t the specialist’s competence (I did my research) or the time and money this would cost me. The surgery was imperative because she already had an FHO in the opposite hip and fractured medial coronoids in both elbows.
My single guiding principle was making sure we controlled Schnitzel’s pain.
I’m referring to real nociceptors in the post-op world, but we experience pain points in practice that also must be addressed. If telemedicine is to succeed, it has to fit into your workflow, have an easy-to-use interface, and not heap more responsibility on overworked staff. Is there a platform out there that checks all these boxes?
No, but there are some that come darn close.
First, find the surgeon…I mean, telemedicine platform. Veterinarians are perfectionists. We abhor mistakes and often would rather do nothing than make the wrong choice. But analysis paralysis is not the way forward.
Do what I did for Schnitzel. Having recently moved to a rural area in a new state, I didn’t have my finger on the pulse of referral practices to use. So I asked trusted colleagues and investigated their recommendations by researching websites and testimonials myself. Follow those same steps for telemedicine. Survey the landscape. Evaluate what parameters are most important to you (cost, reputation, user interface, customer support, PMNs integration, automatic billing, etc.). Pick three companies to research. Narrow the field from there.
Next, realize that the “surgery” (i.e., the leap into telemedicine) will cost you. Only you can decide if the outcome is worth it. Simply put, you will have to learn a new system and train your staff to recommend telemedicine where appropriate. Don’t let that shudder traveling down your spine have the last say. The following chart summarizes the costs and benefits of telemedicine.
Remember, the fear of change is often worse than the change itself. But whether we are told that seasoned veterinary assistants can no longer intubate, even on insanely busy surgery days, or that we must upend our workflow to offer curbside care, veterinarians are adaptable professionals. If the benefits outweigh the cost, we get it done. Period. That is who we are.
Do The Right Thing
To the credit of our profession, the third major obstacle to offering telemedicine is the genuine worry that we will miss something on a digital screen that we would pick up in person; that we will do wrong by our patients and not even realize it. But we all know we can as easily miss a clue in person as on a screen. In Part 2 of this series, I tackle this topic in more detail…and make the case that the mindset we must employ for telemedicine consults will elevate the quality of our in-person exams.
That, my friends, is a win-win.