I was recently attending a continuing education conference, and during our break I overheard a veterinarian in the chair next to me do a telemedicine consultation over his cell phone. He was asking the pet's name, age, etc. and what was going on with her after he had introduced himself.

I didn't listen after that, but it made me curious. I read an article earlier this year about how this would become a hot topic in our profession. I had a lot of questions about the legal implications and how exactly telemedicine works.

What Does A Tele-Exam Entail?

• It can occur when a vet is not available, if the client is in a remote location and does not have access to veterinary care
• It can be in chat form online (you know where the little bubble pops up and asks what's going on with your pet)?
• It could be a consultation or second opinion, given by reviewing medical records about a pet, sent by email or other internet means.
• Reviewing photos of a pet or condition so the veterinarian can see visually what may be going on with the patient in order to provide advice
• Face to face interactions with the client and pet through live video

Some Existing Platforms for this type of exchange:

• PetZam This is an app that connects veterinarians to their clients for live consultations. It requires a Veterinarian-Client-Patient Relationship (VCPR).
• Just Answer is an online-dialogue box where an owner can type in their pets symptoms, and at the bottom, it says how many vets are online at that time to ask an expert.
• Fuzzy Pet Health is a subscription service allowing live chat with the veterinarian, or the client can book an in-home visit.
• Healthy Pets (Canada) provides virtual veterinary consultations through their platform.
• PetCoach Ask a Vet Online provides online consultation, 24/7

Recommended Guidelines:

• Establishment of a VCPR is a must. This insures that the consulting vet takes responsibility for making medical recommendations that and ensures that they know enough about the pet to make a preliminary diagnosis or recommendation for the pet's medical status.
• Know the legal ramifications of performing services such as this within your state, or for clients out of your state. For example, it may be illegal to treat pets outside of a state where you are licensed to practice.
• Consult an attorney before you jump into this as a business to understand the legal  aspects and risks associated with it.
• If a VCPR has not been established (i.e. you are providing medical advice without ever having seen the patient or having previous knowledge about their case), advice given via electronic means should be kept general and not specific regarding the diagnosis or treatment. Don't be liable for giving bad advice or recommendations to a pet you have never actually put your hands on or seen previously.

I feel like I already do many of these tele-exams through e-mail at work for my patients when they send over a question or a photo. Maybe that is a clue that I should be charging for that service! What are your thoughts on Telemedicine and could you see yourself as an "online" practitioner in an actual platform such as listed above?

In most cases, if you don't know the client or the pet personally, it would likely end up with the advice that they actually see a veterinarian in-person. I think about the appointments we schedule that half the time aren't at all what it says in the description of why they are coming in. Nothing can take the place of a real hands-on thorough examination. 

AVMA statement on Telemedicine:

"The AVMA recognizes that future policy in this area will be informed by evidence-based research on the impact of telemedicine on access to care and patient safety.

With the exception of emergency teletriage, including poison control services, the AVMA opposes remote consulting, including telemedicine, offered directly to the public when the intent is to diagnose and/or treat a patient in the absence of a VCPR."