A proposed bill “authorizing the provision of health care services through telemedicine and telehealth” (S291) is now on the desk of the Governor of New Jersey for action.
The bill, which authorizes “the provision of health care services through telemedicine and telehealth” governs such services provided by veterinarians, as “[h]ealth care providers,” fails to acknowledge or provide for issues specific to veterinary medicine. For example, several provisions require the “patient’s request” before providing health care services through telemedicine. Clearly animal patients cannot request treatment or provide consent. The bill fails to distinguish a “patient” from a “client” or “animal owner” or to permit such services at the request of a client/owner for the patient which is the fundamental way in which services are provided in a veterinary practice.
The bill also requires “[e]ach telemedicine or telehealth organization operating in the State . . . [to] annually register with the Department of Health” and submit an annual report providing
the total number of telemedicine and telehealth encounters conducted; the type of technology utilized to provide services using telemedicine or telehealth; the category of medical condition for which services were sought; the geographic region of the patient and the provider; the patient’s age and sex; and any prescriptions issued. The commissioner may require the reporting of any additional information as the commissioner deems necessary and appropriate, subject to all applicable State and federal laws, rules, and regulations for recordkeeping and privacy.
Such information would be publicly accessible pursuant to the State’s Open Public Records Act, which may be of concern to biomedical research entities since reported information can reveal confidential information and trade secrets.
That said, the evolution of veterinary medicine necessarily involves telemedicine. The American Veterinary Medical Association (AVMA ) acknowledges as much in its published “Final Report on Telemedicine” dated Jan. 13, 2017, drafted by the association’s Practice Advisory Panel (AP).
The AP concluded, in part:
Telemedicine is a tool of practice, not a separate discipline within the profession. The AP recognizes that using telemedicine in the delivery of veterinary medical services offers benefits to animal owners, animal patents, and the profession itself. The appropriate application of telemedicine can enhance animal care by facilitating communication, diagnostics, treatments, client education, scheduling, and other tasks within the veterinary profession. Practitioners must apply existing laws and regulations to the provision of telemedicine services in the state they have license to practice veterinary medicine.
The AP recommends that telemedicine shall only be conducted within an existing VCPR [veterinarian client patient relationship], with the exception for advice given in an emergency care situation until that patient(s) can be seen by or transported to a veterinarian. Without a VCPR, telemedicine should not be practiced, and any advice given should remain in general terms, not specific to an individual animal, diagnosis, treatment, etc.
AVMA’s Greg Cima outlined the issues involving telemedicine in “Defining relationships: AVMA considering what medical services can be provided at a distance” posted on May 10, 2017.
At issue is the line between advice and the practice of veterinary medicine, the very issue-in-suit in Hines v. Alldredge, 783 F.3d 197 (5th Cir. 2015) where “a Texas veterinarian . . . was found to have violated the state practice act by performing veterinary medicine without a physical examination or premises visit” when he provided advice via the internet.”
With the decreasing numbers of food animal practitioners across the country, issues of telemedicine will be increasingly important to ensure that livestock receive appropriate and timely medical care.
Companion and other animals will also benefit from the proper use of telemedicine by veterinarians, after the veterinarian-client-patient relationship has been established.