Please also see Part 1 blog post on Telemedicine regarding VCPRs (Veterinarian Client Patient Relationships), practice facilities and prescribing, published on August 28th, 2022.
What about Medical Records for telemedicine appointments???
The obligation of veterinarians to create, maintain and keep-current a medical record for each patient, and the responsibilities for retaining, keeping secure, ensuring that the client has ready access to, and providing timely disclosure of the information in the medical record are not altered when utilizing telemedicine to provide veterinary services. The requirements for medical record keeping established in the bylaws and standards of the CVBC still apply.
CVBC Bylaws, Part 4 – Ethics and Standards (See Division 4.5 – Medical Records)
Even if you are being connected with your telemedicine clients through a third-party telemedicine platform, you are required to retain your medical records at the practice facility through which you are practicing. [even if the third-party platform stores a copy of your records in their own software system]
What About Continuity of Care?
Regardless of how a patient has received care, whether it be through telemedicine, or in person, it should be understood that the patient’s next veterinary appointment may be with another veterinarian. This could be because they return to their regular veterinarian, establish a new in-person veterinarian relationship, or seek telemedicine services through the platform again and get matched with a different vet.
It is vital that a complete and detailed medical record of your services is accessible to the client and/or available for timely transfer to another veterinarian upon request. This is the veterinarian’s (and the Designated Registrant of the practice facility’s) responsibility.
Gathering information about the client’s regular veterinarian and confirming with the client if they would like you to forward a copy of your records directly to that veterinarian should be a part of the conversation.
What if a patient has an adverse reaction to a treatment you prescribed through telemedicine?
The CVBC’s bylaws set the expectation that veterinarians will anticipate and address the possibility that a patient could have an adverse reaction to a treatment they have prescribed. The risk of adverse reactions and options available to the client to receive assistance in the face of a reaction should be a part of the informed consent conversation. The fact that services are being provided via telemedicine does not make the responsibilities of the VCPR any less than those of in-person services. As the veterinarian providing the services, you should consider which of the following options might be most appropriate in each instance (factoring in client/patient location, condition being treated, general status of the patient, nature of the treatment prescribed and severity of the potential adverse reaction, etc.):
- Whether it is reasonable and practical to direct the client to contact your practice facility directly should their pet experience an adverse reaction following your telemedicine appointment;
- If it is possible for them to connect back with you directly through the third-party telemedicine platform through which you were matched, to discuss the pet’s reaction and determine if intervention is necessary
- To direct them to contact a local emergency facility (if available) and ensure they have a copy of their medical records to bring with them;
- If they have a regular veterinarian, this may be an option for them, but you should not expect that their regular veterinarian will be available to deal with adverse reactions resulting from your treatment (unless the regular veterinarian directed their clients to use the telemedicine service as a resource for after-hours care…);
- Recommend that they seek further care via the same telemedicine platform, where (presumably) the next vet would have direct access to the patient’s telemedicine medical records.
In summary, telemedicine may be a useful practice tool to extend care to animals that may not be able to be seen in clinic. However, the responsibilities of the attending veterinarian and their affiliated practice facility are the same as if the animal was seen in person. Complete medical records, informed consent and clear communication with the client and planning for the unexpected are vital to ensuring continuity of care.