Relationships first. Technology Forward

The NYSVMS Executive Board voted to sign on to the Coalition for Connected Veterinary Care during their meeting on September 16th.

The new Coalition was launched by AVMA at their Annual Conference in July. Veterinary Medical Associations were invited to join and so far 25 State Associations have joined, along with two leading telehealth companies. They join AVMA and many national specialist organizations, corporate practice groups and leading suppiers.

Technology offers great possibilities for enhancing veterinary patient care – and much of its potential remains unrealized. This presents our profession with a challenge: How can we increase awareness of the benefits of telehealth and encourage more veterinarians to use tools of telehealth in practice?

We believe the answer lies in a collaborative, grassroots approach. That’s why we have joined the Coalition for Connected Veterinary Care, an alliance of veterinary and animal health organizations united to empower veterinarians to explore and integrate tools of telehealth into their practices in ways that work for them. Why? To better serve patients, clients, veterinary teams, and practices in a variety of ways:

• Strengthen relationships among practices, clients, and patients
• Improve continuity in patient care
• Fully engage technology to advance care
• Enhance practice efficiency

Working together, the Coalition for Connected Veterinary Care provides advocacy and resources that respect the integrity of the veterinarian-client-patient relationship and support the way veterinarians practice.

NYSVMS joined the Coalition for Connected Veterinary Care because of concern about discussions across the nation about changing the definition of the Veterinary Client Patient Relationship (VCPR) to make better advantages of the benefits offered by Telehealth.

In New York State the VCPR is part of the Guidelines for Professional Practice and not part of the State law, which requires a veterinarian to have sufficient knowledge of the patient to initiate at last a general or preliminary diagnosis of the medical condition of the patient, together with medically appropriate and timely visits by the patient to the veterinary facility where the veterinarian is working. This provides the flexibility veterinarians require to provide emergency care via telehealth in the context of continuing care in-person (See notes at the end of this post).

As members of the Coalition for Connected Veterinary Care, NYSVMS supports the following statement of commitment along with the other coalition members.

Veterinary Telemedicine and the Veterinarian-Client-Patient Relationship

Veterinary telehealth and, in particular, telemedicine, holds great promise for improving continuity of care and strengthening the relationship between veterinarians, their clients, and their patients. Used appropriately, telemedicine can enhance accessibility, client communication, and ongoing monitoring and care of veterinary patients.

The veterinarian-client-patient relationship (VCPR) is fundamental to veterinary practice, and establishing it appropriately is necessary for the responsible provision of high-quality veterinary care. Veterinary telemedicine should only be conducted within an existing VCPR, with the exception of advice given in an emergency until the patient can be seen by the veterinarian. An in-person examination or timely visits to the premises where the animals are kept is critical to establishing the VCPR.

• For a veterinarian to diagnose and treat an animal, and to prescribe or dispense medications, a VCPR must be in effect that meets requirements under the state’s Veterinary Practice Act.
• A federal VCPR must be in place to use FDA-approved animal drugs in any manner that differs from their approved labeling, use any FDA-approved human drugs (including over-the-counter medications), use compounded drugs, authorize a Veterinary Feed Directive (VFD), and use certain USDA-approved biologics. FDA requires an in-person examination or timely visits to the premise where animals are kept for these common activities because this degree of oversight is necessary to ensure that medications, including antimicrobials and controlled substances, are used judiciously and to protect the quality and safety of the nation’s food supply. A federal VCPR cannot be established through telemedicine.
  
• It is essential for the ethical practice of veterinary medicine. The AVMA’s Principles of Veterinary Medical Ethics requires a VCPR be established in-person. A veterinarian must be familiar with the animal, its medical history, and the client to provide the best possible care.

Without an initial in-person examination or visit to the premises where the animals are kept, the risks of misdiagnosis, failure or delay in conducting appropriate diagnostics, and ineffective treatment (including inappropriate prescribing) increase and can lead to poor clinical outcomes. In addition, veterinarians treat a multitude of species that can be affected by a large number of diseases and conditions. Failure to identify, properly diagnose, treat, and control zoonotic (e.g., rabies, ringworm, scabies, methicillin-resistant Staphylococcus aureus [MRSA] infection, glanders, some influenzas) and other high-consequence diseases (e.g., African swine fever, foot-and-mouth disease) can have significant adverse public health and/or economic impacts.

Veterinary telemedicine is most effective and safest—for patients, clients, and veterinarians/veterinary practices—when used to maintain a VCPR that has already been established via an in-person examination.

We support the recommendation of the American Veterinary Medical Association (AVMA) that a VCPR should not be established via electronic means.

 Footnote

Can I provide Telehealth Without a VCPR in New York?

In NY State the VCPR is not in statute but in the veterinary guidelines. Note that law, rules and regulations, not guidelines, specify the requirements for practice and violating them constitutes professional misconduct. Not adhering to guidelines may be interpreted as professional misconduct only if the conduct also violates pertinent law, rules and regulations, some citations of which are listed at the end of the guidelines.

To fully understand this issue we recommend listening to a Podcast we put together that includes interviews with our lawyer and the Chair of the NY State Board of Veterinary Medicine.

Here is a summary of their conclusions:

• Although you may not be found guilty of malpractice for providing treatment without a VCPR, a civil suit could be brought against you. The court will look at the current standards applied in the industry, such as the New York State and AVMA guidance on establishing a VCPR. If you have not followed those standards you would need to have a strong and convincing argument that the treatment was provided in an emergency situation. For example during Covid-19 an argument could be made in some particularly high-risk situations that treatment was necessary without an in-person examination, but this should not be the norm even during Covid-19

• The State Licensing Board will hold you accountable for following the guidelines wherever possible, and if there is a variation from the guidelines you will need to be able to present convincing arguments that it was necessary.