Playing Catch-Up in Telemedicine

August 1, 2024

The veterinary industry was years behind human medicine in establishing virtual patient relationships. Thankfully, the tide is turning.

Telemedicine’s short history in U.S. animal health care began with the 2016 formation of the Veterinary Innovation Council. That year also saw the council issue Model Practice Act language and the American Association of Veterinary State Boards host a debate between me, Dr. Lori Teller (representing the American Veterinary Medical Association) and AskVet CEO Cal Lai. That meeting led to the AAVSB conducting two years of due diligence.

The growth of telemedicine proceeded apace with these other milestones:

2018: AAVSB endorsed veterinary telemedicine with guardrails.
2020: The Veterinary Virtual Care Association was formed.
2020-2021: Restrictions prohibiting a virtual veterinarian-client-patient relationship were waived by 17 states and the U.S. Food and Drug Administration amid the COVID-19 pandemic.
2023: Arizona and California unanimously joined Virginia, New Jersey and Idaho in allowing a telemedicine VCPR.
2024: The Florida Legislature unanimously approved veterinary telemedicine and a virtual VCPR.
Today: 108 million Americans live in jurisdictions that allow a relationship with a veterinarian to start virtually.

Waiting to Erupt

I’ve been involved in this subject since the fall of 2015, when I wrote an article as a prelude to the formation of the Veterinary Innovation Council. I’ve been asked more times than I can count, “How does the adoption of telemedicine in animal health care compare to the adoption in human health care?” You might be surprised that the pace is similar.

In human medicine, it started with a few states willing to be pioneers, then exploded. Now, all 50 states allow a doctor-client relationship to start electronically, almost always using real-time video communication.

Take a look at this timeline showing human medicine’s adoption of telemedicine, and then we’ll compare it with animal health care.

1993: Oklahoma
1995: Louisiana
1996: Arizona, California, Oregon
1997: Texas
2001: Florida
2003: Mississippi
2004: New Mexico
2005: Georgia
2007: Pennsylvania
2009: New Hampshire, Wyoming
2010: North Carolina, Virginia
2012: Maryland, Michigan, Ohio
2013: South Carolina
2014: Montana, New York
2015: Arkansas, Colorado, Idaho, Illinois, Indiana, Iowa, Minnesota, Nevada, Tennessee, Vermont, Washington
2016: Alaska, Hawaii, Maine, Missouri, Utah
2017: Nebraska, New Jersey, North Dakota, Wisconsin
2018: Delaware, Kansas, Kentucky
2019: South Dakota
2020: Connecticut
2021: Massachusetts, Rhode Island, West Virginia
2022: Alabama

The Early Days

We’ll start with additional background. Telemedicine grew its first legs in the United States in the late 1960s and early 1970s when the federal government funded seven telemedicine research projects. The objective was to demonstrate equipment capabilities and applicability to human health care and evaluate whether telemedicine had the ability to solve the critical medical staffing shortage in rural areas.

Because of the nature of technology then, telemedicine looked different than it does today. The transmission of information was primarily through phone calls, closed-circuit television and video telecommunication. During that time, a remote diagnosis was possible through interactive televisions and medical records, and laboratory data could be transmitted successfully.

In 1993, Oklahoma was the first state to adopt publicly available telemedicine practices. The first implementation was “store and forward” telemedicine, meaning a patient or physician collected the medical history, images and reports and sent everything to a specialist for a diagnosis. This practice was asynchronous and not real-time communication between a physician and patient as we think of it today. Oklahoma provided telemedicine to 45 rural hospitals and 15 regional hospitals with the goal of improving access to medical care for rural citizens.

In 1997, state lawmakers unanimously passed the Oklahoma Telemedicine Act, which required all health care service plans, including disability insurers, workers’ compensation programs and state Medicaid, to cover telemedicine services, broadening access for many more rural citizens.

Five other states took action in 1995, 1996 and 1997: Louisiana, Arizona, California, Oregon and Texas. Each took unique approaches, often smaller steps, because of the lack of precedents or early models to follow.

The early human health adopters were joined in the late 1990s and early 2000s by Florida (now a veterinary telemedicine state), Mississippi, New Mexico and Georgia — a mix of large and small jurisdictions. Then, 2010 kicked off a wave of states, and all are on board now. Their approaches might be different but each allows for the doctor-client relationship to begin virtually. No state denies the use of telemedicine for the many categories of patients who require another person to speak for them, such as dementia patients, stroke victims and infants.

Fading Criticism

The pace of adoption accelerated as the states became familiar with telemedicine and its capacity to support, but not replace, traditional care modalities, and its ability to step in when clinic visits were unrealistic. While critics remained in organized human medicine, their numbers shrank as the evidence didn’t back up the fears.

Today, legislators nationwide are asking, “It works for people, so why not pets?”

Will the fight for veterinary telemedicine continue in individual states? Certainly, but the pace of early adoption mimicking human health care suggests a wave of states will approve virtual VCPRs in the next five to 10 years. And perhaps, critics will accept that telemedicine is a tool and not a replacement for in-clinic care. It is an essential support system for pet owners unable to access care due to geographic or transportation factors, financial reasons or chronic veterinarian shortages.

History tells us change will win in the end no matter how long it takes.