Remote consultations (telemedicine, technology-assisted consultations)
Updated 3 April 2020
Remote consultations during the COVID-19 pandemic emergency
Direct physical examination of a patient by a veterinary practitioner is central to quality veterinary care. However, for the period of the COVID-19 pandemic emergency, the Board takes the view that remote consultations may provide an adequate alternative to face-to-face consultations.
Wherever possible, remote consultations should be used only for animals or cohorts of animals who have previously been examined by the practice, and for whom a bona fide client relationship exists. However, the Board recognises that during this state of emergency a veterinary consultation may be required for animals who are unable to be physically examined, unable to access their regular veterinary practitioner's services, or are yet to come under the care of any practitioner. In these instances, practitioners may seek to establish a bona fide client relationship via remote consultation if a primary in-person consultation cannot occur because of government social distancing or quarantine requirements. The Board considers that a formal written referral of a case to another registered veterinary practitioner (general or specialist) establishes a client-vet-patient relationship for the secondary practitioner.
The diagram at the bottom of this page may assist veterinary practitioners in Victoria who are considering the use of telemedicine during the COVID-19 pandemic state of emergency.
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Establishing a bona fide relationship for a remote consultation
To establish a bona fide client relationship for the purposes of COVID-19 pandemic emergency remote consultations:
- the veterinary practitioner should attempt to obtain and review previous clinical records for the animal where possible, and
- the veterinary practitioner must perform sufficient due diligence in gathering all possible information from the client and remote examination (photos, videos etc) to be familiar with the current management and health status of the client’s animal/s, and
- the client must be responsible for the animal husbandry and/or day to day management of the animal(s), and
- the veterinary practitioner must maintain clinical records for that animal or cohort of animals, and
- the veterinary practitioner is available, or has arranged, for adequate ongoing/after care if required.
Practitioners are reminded of the importance of considerations for continuity of care. It is the Board's view that if a practice is unable to open because of illness or insufficient staff, veterinarians are reminded that they must have made arrangements for:
- emergency referral for their clients
- access to veterinary medical records, where needed, for continuity of care.
Therefore, the Board recommends that veterinary practitioners plan ahead, in collaboration with neighbouring practitioners, to ensure continuity of care for their animal patients.
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Constraints on remote consultation
The decision to provide a remote consultation is the responsibility of the individual veterinary practitioner exercising their professional judgement, and should be conducted under the following constraints:
- Ownership of the animal must be established by the veterinary practitioner, and all discussions about treatment veterinary services must be directed to the owner.
- Where the animal OR the veterinary practitioner is located in Victoria, the veterinary practitioner must be currently registered, or have their registration recognised, in Victoria.
- A bona fide client relationship must be established.
- The integrity and confidentiality of the bona fide veterinarian–client–patient relationship is maintained.
- The owner is provided with options which include access to a hands-on patient consultation.
- The owner should provide informed consent for the remote consultation (i.e. in writing via text, email), including recording their knowledge and understanding of who is providing the service (name, location, practice affiliation (if any) and any conflicts of interest) and the limitations of remote advice.
- The veterinary practitioner conducting the remote consultation can assure themselves that the history and subjective information provided by the owner, by telephone or video, is sufficient to implement a therapeutic plan.
- A full veterinary medical record is maintained for each remote consultation. The record should include all information about the case, including those aspects that cannot be determined remotely; all points of discussion with the owner about treatment options; recommendations and decisions, and reasons why a hands-on patient examination was not performed.
It is the Board’s view that remote consultations may be used to provide general advice or health information and to undertake some general triage to determine the urgency or need for immediate referral to a veterinary practitioner for direct care. The Board reminds practitioners that they must exercise caution in offering any presumptive diagnoses, prognoses and therapeutic recommendations remotely, and must clearly communicate any limitations in doing so and alternative options to the owner.
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Considerations for professional judgement during remote consultation
When exercising their professional judgement during a remote consultation, a veterinary practitioner is expected to consider:
- Have I or my colleagues examined (physically or remotely), obtained sufficient history, and made appropriate records about this animal recently enough to allow current understanding of its health and management status?
- Is this a condition or complaint that can be adequately assessed remotely?
- Is a physical examination of the animal needed?
- Is a blood test or other diagnostic test required? Can any samples be safely and feasibly collected and submitted by the owner/agent without compromising animal wellbeing?
- What is the scope of the advice I can appropriately provide, given the limited contact/inability to physically examine the animal?
Where there is any element of doubt as to whether telemedicine is appropriate or adequate for a particular case, the Board recommends that the veterinary practitioner consult with another veterinary practitioner and record their peer’s opinion in the medical record.
When viewing professional conduct during the state of emergency, the Board notes the exceptional circumstances in which veterinary practitioners are operating, in order to prioritise both human and animal health and safety. Decisions made by veterinary practitioners, including the provision of telemedicine services, should be guided by current information and must be documented and justifiable, based on current restrictions and the professional standards expected by their peers and the public.
Additional source: AVA Telemedicine Policy (March 2020).
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Remote prescription and supply of medication
If you have questions about prescription and supply of medicines after reading the information below, please direct them to the Office of Medicines and Poisons Regulation (Victorian Department of Health and Human Services).
If prescribing or supplying medications during a remote consultation, veterinary practitioners must ensure that they comply with Regulation 38 of the Drugs, Poisons and Controlled Substances Regulations 2017
and Board Guideline 6: ‘Supply and use of drugs, scheduled drugs and other medications in veterinary practice’
. Requirements include ensuring that:
- the client is a bona fide client (or the agent of a bona fide client)
- the animal/herd is under the care of the veterinary practitioner
- a therapeutic need for the drug or medication has been established (and for scheduled medications, that all reasonable steps have been taken to establish a therapeutic need)
- side effects and precautions for the use of the medication have been discussed with the owner
- appropriate clinical records are kept, and
- provision is made for after-care if needed.
To ensure that animals – whether examined physically or remotely – are satisfactorily “under the practitioner’s care”, the owner or their authorised agent must give the veterinary practitioner consent and responsibility for the animal or cohort’s health. There must be evidence of the practitioner personally having contact (physical or via technology) with the animal, or group of co-managed animals, for diagnostic and treatment purposes and of assuming responsibility for their diagnosis, treatment and outcome.
To adequately support such a responsibility, a veterinary practitioner should know and consider:
- The status, stability, and response to treatment of the condition and the animal requiring medication.
- Any risk factors that may predispose an animal to undesirable side effects of medications.
- Concurrent health problems whose treatment or monitoring may influence the appropriateness of other medications.
- Concurrent medication which may require review before prescribing/resupplying other medications.
- Requirement to provide scientifically-based recommendations for withholding periods, which consider the animals’ disease and treatment status.
- Any management or environmental factors which could be addressed within treatment recommendations to influence the ongoing need or efficacy of medications, particularly noting veterinarians’ commitment to responsible antimicrobial stewardship.
- The ability of the owner or agent to successfully and accurately administer the medication supplied.
- Any future actions required to support the practitioner’s professional judgement, which may include rechecks, further diagnostics, and specific/detailed monitoring.
Where a veterinary practitioner provides services to a group of animals, the practitioner should conduct an epidemiological investigation to identify risk factors for disease. This could include (but is not limited to) nutrition, housing, movement, preventative treatments, climate and geography, inter-animal and human-animal contact, prior and existing cohort health status.
Practice notes should be recorded within the enterprise's history to include salient features of epidemiological investigations, with reasons behind the supply or scripting of medications.
Prescription and supply of medication during a remote consultation must continue to be legal, safe and practical.
For the full list of matters to take into account when supplying medications, refer to Board Guideline 6: ‘Supply and use of drugs, scheduled drugs and other medications in veterinary practice’.
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Telemedicine decision-making diagram
The diagram below may assist veterinary practitioners when considering the use of telemedicine during the Covid-19 state of emergency:
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