Solutions and Regulations for Telemedicine Vet Care

I was recently asked what solutions I have seen implemented around veterinary liability in case of adverse medication reaction or a poor response to telemedicine vetcare/treatment. This is a policy related speed bump for telemedicine, but in order to provide care to underserved/remote/rural areas it is something that needs ironing out.

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I think proper guardrails for telemedicine are critical. The Veterinarian Virtual Care Association has created regulations to provide guidance for practitioners, associations, legislatures and state boards of veterinary medicine They are as follows:

1. Subject to the judgment and decision of a licensed veterinarian, a virtual veterinarian-client-patient-relationship (VCPR) may be established, provided:
   - There is video communication between the parties through which the animal is observed or the veterinarian obtains current knowledge of the animal patient through the use of instrumentation and diagnostic equipment through which images and medical records may be transmitted electronically. Real-time video engagement is not required for the delivery of telemedicine services after a VCPR is established.
   - If medical records exist from a previous in-person visit and are available to the client, the records (including diagnostic data if available), are encouraged to be transmitted electronically to enable the veterinarian to obtain historical knowledge of the animal.

2. Privacy protections must be in place and confidentiality maintained for the client and patient.
3. The veterinarian must be licensed in the jurisdiction in which the client primarily resides, or in which the patient is present at the time of the virtual examination.
4. Telemedicine must be practiced in such a manner that the veterinarian is prepared to refer or supply the pet owner with contact information for veterinary practices in the pet’s location in case the pet owner seeks in-person care.
5. A virtual VCPR requires documented consent to a telemedicine visit from the animal owner to the veterinarian, including acknowledgment that:
   - The same standards of care under the state veterinary practice act and regulations apply to telemedicine and in-person medical services.
   - The animal owner has the option to choose an in-person visit rather than telemedicine service.
6. Subject to FDA regulations and AMDUCA provisions regarding extra label drugs, veterinarians should give careful consideration to prescribing any medications, especially antimicrobials, but they may prescribe after establishing a virtual VCPR based upon their professional judgment with the following conditions.
   - Prescriptions based on a virtual VCPR should be issued initially for no more than 30days, and may not be renewed for more than 30 days without an additional virtual or in-person examination.
   - A prescription renewed once and based upon only virtual examinations may not be renewed again without an in-person examination.
7. An in-person examination is required for controlled substance prescriptions, exceptfor limited dosage deemed essential by the veterinarian to maintain an animal’s safetyduring transport to a clinic for in-person examination.