April 2020 by Dr. Michael (Mike) Greenberg, DVM, Director of Outreach Programs, Maddie's Fund
Audience: Executive Leadership, Foster Caregivers, Public, Shelter/Rescue Staff & Volunteers, Veterinary Team
What is the difference between telehealth, telemedicine, teletriage, etc.?
In the world of telehealth, there are a lot of terms that sound similar, but they're not synonymous. Understanding the differences between these terms is key to understanding the field, particularly as it relates to the legal questions that a lot of us have. This isn't an exhaustive list, but here are three of the most important terms to grasp:
- Telehealth is a general term. It refers to any use of technology to provide health-related information remotely. Other common terms in this field are sub-types of telehealth.
- Teleadvice refers to providing general health information remotely. It does not pertain to a specific animal. An example of teleadvice would be a veterinarian explaining to a pet caregiver that pets need to be closely monitored for pain after surgery. Giving teleadvice does not require an established veterinary-patient-client relationship (more on this below)
- Teletriage has the specific aim of helping a pet caregiver if they need to take their pet to a veterinarian based on the conditions they are observing. For example, a caregiver may notice their dog limping suddenly on a Sunday night. A vet providing teletriage would help the caregiver decide if they need to head to an emergency clinic or it would be okay to wait until morning. Teletriage does not require an existing veterinary-client-patient relationship.
- Telemedicine is the remote diagnosis and treatment of conditions for a specific pet. Importantly, telemedicine does require a veterinary-client-patient relationship. For example, a caregiver has a pet with recurring seasonal allergies. They speak to their veterinarian via video chat. The vet observes the pet itching and reviews the record, then calls in a prescription for allergy medication. This is telemedicine.
For more information, check out: AVMA: Telehealth Basics
Is telehealth legal?
For any questions pertaining to legality, it is important to consult your state's veterinary practice act. You can also call your state's veterinary boards directly. To do so, you can usually simply do a web search for "[your state] veterinary practice act" and find it. A lot of the questions of legality surround the idea of a "veterinary-client-patient relationship" (VCPR). Check out some of the following questions for more on that.
- Pro tip! Don't forget that if you have questions about legal issues, you can often go straight to the source and call your state's veterinary board; they're typically the ones who write the practice acts. They tend to be accessible and happy to answer questions; that's part of the reason they're there!
- For more information: Clinician's Brief: Coronavirus & Telemedicine
Do telehealth laws change during states of emergency?
This is another area that varies on a state-by-state basis and can often vary depending on the specific emergency. It is important to check your state veterinary board and/or practice act.
What is a veterinary-client-patient relationship (VCPR) and how do I know if I have one or need one?
The definition of a VCPR varies slightly from state to state. In most states, a VCPR exists when a veterinarian has seen the pet in person, has access to the pet's medical history, and enough working knowledge of the patient to provide at least a general diagnosis. For more information:
- AVMA's VCPR State Laws. A summary of VCPR information for all 50 states.
- AVMA: Telehealth & the VCPR
How long does a VCPR last?
This is a particularly difficult question to answer. Few states - if any - give a precise answer to this question, nor does the American Veterinary Medical Association. You will often see phrases like, "...veterinarian must have performed a timely examination...". These sorts of phrases are intentionally vague, allowing the veterinarian to use his or her professional judgment.
Is the VCPR different in a shelter situation where a vet is dealing with a population as opposed to individual animals
This is another situation that is rarely, if ever, clearly described. Some shelter veterinarians look to farm animal veterinarians as a model for this situation. Farm animal veterinarians are generally not required to have as VCPR with every animal on a farm, but instead must have an established relationship with the population and the farmer in which they have visited the farm and have a working knowledge of the farm's protocols and practices. Again, check with your state's veterinary board to be absolutely sure.
How can I set up a simple telemedicine system for my shelter or rescue?
Setting up a basic telemedicine service at your shelter or rescue is actually pretty simple. Of course, you will need to have an established relationship with a veterinarian who is ready to take this on. Next, you'll need each of the following; an online scheduling system (not necessary but helpful), and a web-based method to keep records of calls.
The details for setting up a system varies according to your needs and whatever technology you may already have in place or be familiar with. But here are the basics and some examples of user-friendly tech options. Again, you don't need every single one of these components.
- Video chat: Zoom, Google Hangouts
- Phone and text: Zoom, Google Voice, Google Hangouts, Grasshopper
- Online scheduling system: Calendly, Acuity, Schedulista
- Web-based record-keeping: Google Forms and Google Sheets, Airtable
If I set up a telehealth system, will I need to share my personal phone number?
Nope! There are a ton of available options for free web-based phone numbers that can be routed to your phone but give you an alternative phone number. Check out the options listed above or any others you might already be familiar with.
Can my shelter or rescue organization use teleadvice and/or teletriage services?
There are now several commercially available teleadvice/teletriage services. These 24/7 services may be useful to your shelter or rescue. For foster caregivers, these services help take some pressure off of the veterinary and foster coordination staff. If your shelter does not have a vet, shelter staff can use these services for timely advice. Check out some of the following:
About Dr. Michael (Mike) Greenberg, DVM, Director of Outreach Programs, Maddie's Fund®
Prior to joining the team at Maddie's Fund, Dr. Mike served as program director for Target Zero, helping communities across the US achieve 90% or greater live release rates from their animal shelter systems through implementation of best practice strategies. Following veterinary school, Mike worked in rural private practice. It was there that he began volunteering with shelters and working with shelter staff and leaders to address community issues to increase lifesaving. Having caught "the bug," Mike took the plunge into the sheltering world, and completed his training in shelter medicine with the Maddie's® Shelter Medicine Program at Cornell's College of Veterinary Medicine in 2011. Since that time, he has worked clinically and as a consultant for multiple public and private animal shelters throughout the United States. He is based in Nashville, TN where he helped to start Pet Community Center, a shelter intake prevention organization.