Telemedicine - the future in veterinary medicine?

04.05.2017 Recently the Royal College of Veterinary Surgeons (RCVS) announced their decision to review the use of telemedicine within veterinary practice, releasing an online questionnaire for veterinary professionals and the general public. Technology is advancing and its application within veterinary medicine can certainly benefit animal health and welfare, however it may also present certain challenges, potentially changing the nature of the veterinary consult as we know it today. Telemedicine has been well established in veterinary medicine for years with many first opinion vets regularly sending radiographs and test results to specialists for advice on diagnoses and treatment. Some vets report that clients already send pictures or videos of their pets and expect a diagnoses to be made, leaving them uncomfortable and unsure of regulations. This accompanied with the growth in businesses offering online consultations and an increase in new innovative technologies such as canine “fitbits” it is clear that the review is needed. Email, video links and phone calls have the benefit of being able to overcome a patient’s geographical isolation and may mean that earlier diagnoses can occur and stress during transit is minimised. It would also allow clients to show symptoms as and when they happen, reducing wasted consults when the patient reverts back to normal behaviour, much to the annoyance of the owner. However, whilst video and telephone consults can now form the basis for human prescriptions, veterinary consults are non-comparable as an animal cannot verbalise their symptoms (or we cannot understand them!). It is often down to the physical examination of the patient and examination skills of the vet to determine a diagnoses and therefore an appropriate treatment plan. This would be almost impossible to replicate using current technology and perhaps ever. Any change in regulations must take this into account to prevent harm or breaches in animal welfare. Farmers are already benefitting from telemedicine with some using movement sensors to monitor cattle feeding behaviour and activity. The development of new technologies such as temperature monitoring ear tags, said to alert of disease up to 72hours before detectable by a trained expert, could mean that vets can monitor herd health more effectively from a distance between visits. The Whisper stethoscope transmits cattle lung sounds to a computer, analysing and categorising them into five different levels of lung health. This indicates the severity and progression of Bovine Respiratory Disease Syndrome (BRSD) which is challenging to diagnose in the early stages, when treatment is most effective. Earlier detection of disease leads to decreased mortality and potentially more judicious use of antimicrobials, an issue which the entire veterinary profession must take responsibility for. It is clear that new technologies bring benefit yet there must also be strict regulations. The American Veterinary Medicine Association (AVMA) has dealt with this issue by stating that telemedicine can only be practised in the context of an existing vet-client-patient-relationship. In other words, where a physical consult has already occurred, however this relationship must not be maintained by technology alone. However, states vary in their interpretation of this, with some allowing consultation websites to the case of Dr. Ron Hines, the Texan vet, whose license was suspended in Texas after he dispensed advice to pet owners online. He is currently filing a petition for review by the Supreme Court with hopes to practice again. Therefore whilst the AVMA has a telemedicine policy, there still seems to be confusion surrounding what is legal. The responses to the RCVS telemedicine consultation will be reviewed by RCVS standard committee. Certain individuals and organisations will be asked to come and speak further to inform policy-making. It is clearly a tricky issue to navigate legally however may have the potential to better the health and welfare of animals. What are your opinions on telemedicine, is it inevitable or more trouble than it’s worth?