How does veterinary telemedicine work? *H&H Plus*

Remote vetting, or telemedicine, is the provision of veterinary care without the vet being present. Instead, the consultation is held on the phone, via video call, or through text message or email. Telemedicine isn’t new – since the development of mobile phone technology, owners have been communicating with vets in this way, sending photographs, videos and updates remotely. And it works well for non emergency enquiries such as skin problems and minor wound ailments, as well as follow-up consultations, particularly for owners living in remote locations. But for more serious conditions and emergencies, the vet must attend. However, there is a grey area and this applies to the remote prescribing of certain medications. Under normal circumstances, the Royal College of Veterinary Surgeons (RCVS) states that every horse must undergo an examination by a vet before prescription medication can be given, including antibiotics and phenylbutazone (bute). But when Covid-19 hit, the RCVS decided that this rule should be lifted temporarily to allow the remote prescribing of such medicines. [subscriber-content]So how have vets found remote vetting and where do they see it heading in the future? Patrick Pollock, senior lecturer and head of equine surgery at the Royal (Dick) School of Veterinary Studies, works with developing countries, helping working equines and donkeys. And for this, he uses telemedicine. “I hold telemedicine clinics in which I FaceTime a vet at the scene who may ask our opinion on a condition,” says Patrick. “We then offer advice on treatment and follow it up a few days or weeks later. I also provide telemedicine in the form of a consultation service, reporting on X-rays and images that vets send me.” He admits to not having done as much vet-to-client telemedicine in the UK. “We started using it on remote islands in Scotland and it has been gradually rolled out to other clients,” he says. “The main problem is that the RCVS legislation states that a horse must be considered ‘under my care’ to offer remote treatment, so I need to have seen it in person at least once in the past six months.” Rules were relaxed during lockdown so that vets could continue to provide a service, but Patrick saw its flaws. “If in any doubt, I see the horse in person,” he says. “If it doesn’t feel right, it usually isn’t, and I don’t ever want to wonder if I made the right decision or if things would have ended differently if I’d seen the horse earlier.” Vet and H&H columnist Karen Coumbe agrees that telemedicine has its limitations. “We tried to use telemedicine during lockdown, but I found it less useful than I’d hoped,” she says. “Few people seem able to provide sufficiently clear videos and images, so you end up examining the horse anyway.” No hands on Another with mixed views is Liz Somerville, practice manager and director of Loch Leven Equine Practice in Scotland. “We’ve always followed up cases remotely, with clients sending in videos and photos, so it had already started before Covid-19,” says Liz. “For those clients you know well and have a good relationship with, it has its place. The main frustration for some of our vets during lockdown was that they were so used to doing a physical exam and getting hands on, but couldn’t. We also found many owners preferred for their horse to been seen in person.” Telemedicine also raised logistical issues. “We had to have specific vets on emergency calls and put another vet on video consults, because stopping while on the road to do a video consult didn’t work,” adds Liz. Deciding what to charge for remote vetting was also challenging. “We have always offered free advice, especially when the client just wants some reassurance or the vet is following up a case that doesn’t need a visit. But if a tele-consultation is being used as a replacement for a visit, as a profession we need to charge properly for this,” says Liz. “The most important bit is then making sure the client feels they are getting value for money.” Jack Wallace, director at Walnut Hill Equine Veterinary Practice in Warwickshire, is another vet who agrees. “We have a very good level of trust with our clients, so a proportion of our work would include some remote vetting, for which we do not charge,” he says. Jack runs a busy practice with six vets. “The utilisation of telemedicine for following up cases has enabled us to keep up with demand,” he says. “As long as we have a good rapport with the client, have seen a photo or video and have examined the horse recently, then we feel there can be a place for prescribing some drugs remotely. Generally, coronavirus has not been a difficult transition for us.” The advent of telemedicine and relaxation of the prescription rules has, at times, been accompanied by financial savings for clients. “An example would be the avoidance of paying for a call-out fee for a vet to have a look at a small wound that isn’t near a joint and requires basic cleaning and medication,” explains Jack. “A video consultation can be a useful tool that combines a coronavirus-safe approach, reduced cost to the client and no impact on the welfare of the horse. But the relaxation of these rules is unlikely to remain for the long term and while there can be some financial benefits to clients, there are also limitations. “There are some cases that definitely require a visit in person, such as colic, wounds near joints and problems with eyes,” says Jack. “One downside to telemedicine is that we are constantly on our phones and the expectations are high. Can you text your doctor at 10pm at night and expect a reply from his personal mobile? Probably not.” There’s an app for that One thing that has come to light with the increased use of telemedicine is the need for an equine-specific telemedicine app. “There are several good apps for small animal practice, but what I wanted was an equine-specific app – one where clients can book and pay for the appointment up front, then call the vet via video,” says Liz Somerville. “It is then recorded and the vet makes clinical notes on the app. There has been a huge amount of development through lockdown, but it needs a bit more work.” Jack Wallace agrees: “Having an app would be useful so that vets aren’t being bombarded 24/7.” Patrick Pollock has tested Vidtu, an app for remote conferencing and telemedicine. It enables mobile screen and file share, camera and chat over a secure encrypted network. “You pay a fee to access it and it has been developed for low bandwidth areas,” he says. “It works well and is great for recording the consultation, covering yourself against litigation.” Ref Horse & Hound; 12 November 2020 [/subscriber-content]