Ratification Date: 17 Mar 2020
- Veterinarians conducting veterinarian-to-client telemedicine consultations must ensure that they are registered to practise 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.
- A bona fide veterinarian–client–patient relationship must be established, 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.
Veterinary telemedicine practice uses telecommunication technology to undertake remote consultation without the patient being physically present. Technology is rapidly transforming the practice of veterinary medicine, which provides the opportunity to improve the delivery of animal healthcare and welfare; however, it also presents challenges to practitioners, animal owners and carers.
Telemedicine consultation services may occur:
- between a veterinarian and a client for which a bona fide veterinarian–client–patient relationship exists.
- between a veterinarian and a client in a tele-triage capacity (i.e. where a bona fide veterinarian–client–patient relationship does not exist).
Veterinarian-to-veterinarian consultations are not in the scope of this policy and are covered by a separate AVA policy.
Giving veterinary advice without physically examining an animal and establishing a bona fide veterinarian–client–patient relationship may lead to an increased risk of error in clinical judgement. The AVA recognises that because of the existence of separate state veterinary boards and the current absence of a national registration mechanism, the definition of what constitutes an ‘act of veterinary science’ and a ‘bona fide veterinarian–client–patient relationship’ may vary from state to state.
- Attending and consulting veterinarians involved in a telemedical consultation must ensure that:
a. The integrity and confidentiality of the bona fide veterinarian–client–patient relationship is maintained.
b. The telemedicine consultation is practised according to the legal requirements set by the regulatory authority where the attending veterinarian is registered, and the animal(s) is located.
c. A complete and accurate medical record in line with Veterinary Surgeons Board requirements must be produced and retained.
- A veterinarian who provides a veterinary telemedicine service is, by definition, the attending veterinarian, and must be registered in the jurisdiction where the animal(s) is located, or their registration must be recognised in that jurisdiction through National Recognition of Veterinary Registration.
- Credentials of all service providers, as well as disclaimers around the limits of telemedicine resources, should be unambiguously disclosed to the client.
- Veterinarians providing telemedicine services must ensure that clients are aware of the provider’s identity, location, registration status and any potential privacy and security issues involved in accessing veterinary services by telemedicine.
- In a telemedicine consultation, the attending veterinarian assumes responsibility for making medical judgments and ensures that he or she has sufficient knowledge of the patient and the pertinent history, husbandry and conditions in which the animal is kept, to initiate at least a general or preliminary diagnosis and to offer a care program. The veterinarian must also ensure that he or she has sufficient knowledge of disease conditions relevant to the geographical location of the patient(s).
- The veterinarian must be satisfied that the data presented by the client is reliable; he or she must have sufficient trust in the client’s ability to assess accurately and describe signs (for example temperature, heat and swelling, halitosis, abdominal pain) and that the technology is satisfactory for the purpose (e.g. lameness examination).
- Before proceeding with a provisional diagnosis and treatment plan the veterinarian needs to establish how supporting tests can be undertaken (e.g. radiology, haematology and blood chemistry). If supporting diagnostic aids are not readily available, the option of a physical visit or collection of the patient for in-house treatment must be considered and documented.
- As some veterinary practices do not offer veterinary behaviour consultations, telemedicine can be used for behavioural assessments. Important information regarding an animal’s behaviour problem can often be obtained via media sources and history from the owner. Because physical health issues can affect behaviour, any client seeking a veterinary behaviour consultation for their animal via telemedicine should also be advised to obtain a full physical work-up and supportive tests from another veterinarian who can be physically present.
- As required in face-to-face practice, a veterinarian utilising telemedicine should ensure that arrangements are in place for follow-up evaluation, veterinary emergency care and treatment. The veterinarian is expected to provide oversight of treatment, compliance and outcome.
- A complete and accurate medical record is required, in line with the Veterinary Practitioner Board requirements for the jurisdiction in which the animal resides.
- The animal owner’s consent for the use of telemedicine must also be obtained and documented (in writing from the owner, for example by email or text).
- Veterinarians utilising telemedicine should send medical records to the client’s regular veterinarian in a timely manner, and strongly recommend the need for a physical examination if there is a poor response to treatment.
- The supply of restricted drugs must only occur where the the veterinarian has sufficient knowledge of the animal(s) to initiate at the very least a general or preliminary diagnosis of their medical condition. At all times, such supply must meet the requirements under the relevant legislation in both the jurisdiction of the consulting veterinarian and the one in which the animal resides. There are circumstances where remote prescription occurs ahead of the veterinarian’s visit (for example in artificial breeding practice). In all cases adequate instructions, including any risks to humans administering these drugs, must be provided to the client.
- Without a bona fide veterinarian–client–patient relationship, any advice provided through electronic means should be general and not specific to a patient, diagnosis or treatment. This advice and the disclaimers should also be recorded in the animal’s clinical record.
The AVA encourages the development of technologies that benefit the health and welfare of animals and that positively support the veterinarian–client–patient relationship.
In the future, as technologies and medicine advance, appropriate guidelines will need to be developed to reflect how the bona fide veterinarian–client–patient relationship applies in a changing environment. Future policy in this area will be informed by evidence-based research into the impact of telemedicine on access to care and patient safety.
In the meantime, veterinary boards should develop systems to regulate telemedicine practice including:
- the legal responsibilities of veterinarians practicing telemedicine.
- the establishment of a definition of what constitutes a bona fide veterinarian–client–patient relationship, which may not in every case require the veterinarian to examine the patient.
- whether, in the situation where a medication needs to be administered by a veterinarian, or person authorised under the controlled substances legislation, and the client is unable to arrange contact with a veterinarian, it is reasonable for the drug to be administered by a human health professional.
Bona-fide veterinary-client-patient relationship:
The veterinarian-client-patient relationship is important as the basis for most professional interactions. A bona-fide veterinary-client-patient relationship exists where each of the following occurs:
- The veterinarian has assumed responsibility for making judgments regarding the health and welfare of the animal(s) and the need for treatment, with the owner’s (client’s) agreement; and
- The veterinarian has sufficient knowledge of the animal(s) to initiate at least a general or preliminary diagnosis of their medical condition; and
- The animal or herd must have been directly examined by the veterinarian; or
- The animal(s) must have been seen recently enough or often enough for the veterinarian to have personal knowledge of the condition of the animal, or current health status of the herd or flock, to make a diagnosis and prescribe treatment; or
- If the animal(s) cannot be examined due to remote location or other genuine impediment, the veterinarian must be satisfied that he or she has performed sufficient due diligence in gathering all possible information to enable a general or preliminary diagnosis sufficient to prescribe treatment; and
- the veterinarian must maintain clinical records of that herd, flock or individual; and
- The veterinarian is available, or has arranged for adequate emergency coverage, for follow-up evaluation in the event of an adverse reaction or failure of the treatment regimen.
In the above definition, the veterinarian may refer to an individual veterinarian or a colleague veterinarian in a larger multi-vet practice where the outlined conditions are met.
- American Veterinary Medical Association. Telemedicine. https://www.avma.org/KB/Policies/Pages/Telemedicine.aspx. 2017. Accessed October 2017.
- Canadian Veterinary Medical Association. Veterinary telemedicine: Position Statement. https://www.canadianveterinarians.net/documents/veterinary-telemedicine-position-statement. Accessed October 2017.
- Hess L. Telemedicine: The Future of Veterinary Practice. Journal of Avian Medicine and Surgery 2017;31:165–171.
- Royal College of Veterinary Surgeons. RCVS News, March 2017. https://www.rcvs.org.uk/news-and-views/publications/rcvs-news-march-2017/?destination=%2Fnews-and-views/publications%2F. Accessed October 2017.
- Veterinary Information Network. VINNEWS. http://news.vin.com/vinnews.aspx?articleId=38579. 2017. Accessed October 2017.
- Veterinary Surgeons Board Western Australia. Guidelines on veterinary telemedicine. https://www.vsbwa.org.au/wp-content/uploads/2014/10/Guidelines-on-Veterinary-Telemedicine.pdf Accessed October 2017.
This policy is relevant to telemedicine where it relates to veterinary-to-client interactions. Vet-to-vet consultations are covered in the following two AVA policies: