Professional Practice Standard
Published: May 2016
Revised: March 2017, September 2018, June 2022
Introduction
Advancements in technology, in all forms, provide opportunities for new approaches to the delivery of veterinary medicine. As the broader world of veterinary telehealth continues to expand, the College recognizes the value of veterinarians utilizing developments in technology to improve access to the provision of veterinary medicine, where appropriate, and supports innovations in the delivery of veterinary services.
In all circumstances, an individual practising veterinary medicine in Ontario must be licensed with the College of Veterinarians of Ontario and practice from an Ontario accredited veterinary facility. This standard should not be construed to alter the scope of practice of any veterinarian or authorize the delivery of veterinary medicine in a manner not otherwise authorized by legislation or its specific and explicit interpretation by the College. This document supports a consistent standard of practice notwithstanding whether the tools of delivery are physically or virtually based. For clarity, a veterinarian using telemedicine technologies in the provision of veterinary services to a patient (whether existing or new) must take appropriate steps to establish a veterinarian-client-patient relationship and conduct all appropriate evaluations and history of the patient consistent with standards of practice for the particular presentation. As such, some situations and patient presentations are appropriate for the utilization of telemedicine technologies as a component of, or in lieu of, in-person provision of medical care, while others are not.
The College has developed this standard to educate licensed members as to the appropriate use of telemedicine technologies in the practice of veterinary medicine. The College is committed to assuring patient and client access to the convenience and benefits offered by telemedicine technologies, while promoting the responsible practice of veterinary medicine by veterinarians. The College maintains its regulatory authority to investigate any complaints made about a veterinarian licensed in Ontario regardless of whether the veterinarian and/or the animal(s) or group of animals is physically located in Ontario.
Definitions
Telemedicine: Telemedicine is the provision of specific veterinary medical advice and veterinary treatment of an animal(s) or group of animals based on the virtual assessment by means of telecommunications technology where no in-person physical examination or in-person premise visit of the animal(s) or group of animals by the veterinarian takes place. It does not include consultation between veterinarians where colleagues in different physical locations consult virtually with each other or the provision of general, non-specific, advice.
Telehealth: Telehealth is the overarching term that encompasses all uses of technology geared to deliver health information, education or care virtually. Telehealth includes a broad variety of technology and tactics to deliver virtual medicine, health and education services. Telehealth is not a specific service, but a collection of tools which allow veterinarians to enhance care and education delivery. Telehealth encompasses both telemedicine and general advice.
Practice Expectations
A veterinarian meets the Professional Practice Standard: Telemedicine when they:
- Understand that a veterinarian-client-patient relationship is established via telemedicine meeting the same expectations as when the relationship is established in-person in accordance with the Professional Practice Standard: Veterinarian-Client-Patient Relationship (VCPR).
- Understand that practising veterinary medicine via telemedicine is only permitted in the context of a VCPR.
- Understand that telemedicine is a method or mode of delivering veterinary medicine, rather than a new model of practice. Further, a veterinarian’s existing legal and professional obligations are not altered when veterinary medicine is provided via telemedicine.
- Employ sound professional judgment to determine whether using telemedicine is appropriate in particular circumstances each and every time they consider practising via telemedicine, and only provides advice via telemedicine to the extent that it is possible without a physical examination or premise visit. In doing so, a veterinarian must consider whether practising via telemedicine will enable them to satisfy all relevant and applicable legal and professional obligations, and meet the expected standard of practice in any specific case. They do not substitute telemedicine technology for a physical examination or premise visit when either is necessary, and where they could not make an appropriate working diagnosis or create a treatment plan.
- Understand that, in accordance with the Professional Practice Standard: Prescribing a Drug, a veterinarian may prescribe a drug via telemedicine for an animal(s) or group of animals when they:
- have recent and sufficient knowledge the animal(s) or group of animals by virtue of a history and inquiry and either in-person physical examination of the animal(s) or group of animals or medically appropriate and timely in-person visits to the premises where the animal(s) or group of animals is kept to reach at least a general or preliminary diagnosis;
- believe that the drug is prophylactically or therapeutically indicated for the animal(s) or group of animals; and
- is readily available in-person in case of adverse reactions to the drug or failure of the regimen of therapy. - Further understand that, in accordance with the Professional Practice Standard: Prescribing a Drug, a veterinarian may obtain recent and sufficient knowledge through a virtual physical examination or virtual premise visit to prescribe a non-controlled drug to an animal(s) or group of animals when the following conditions are met:
- They conduct a virtual physical examination or virtual premise visit of an animal(s) or group of animals’ circumstances and condition to obtain sufficient information regarding its status and condition to indicate an immediate need for drug therapy;
- The quantity of the drug prescribed is limited to an immediate, short-term need or is the minimum amount necessary to allow the client a reasonable opportunity to obtain in-person veterinary services for the animal(s) or group of animals; and
- They are readily available in-person to manage adverse reactions to the drug or failure of the regimen of therapy. - Practise veterinary medicine via telemedicine only in association with an accredited veterinary facility in Ontario.
- Ensure that the client is aware of the veterinarian’s location, licensure status and the privacy and security issues involved in accessing veterinary care via telemedicine.
- Ensure that they safeguard a client’s privacy when practising via telemedicine by taking appropriate precautions and confirming that the technology and physical setting being used by the veterinarian and client have adequate security protocols in place to ensure compliance with the veterinarian’s legal and professional obligations to protect clients’ privacy and confidentiality.
- Ensure that the technology used with respect to practice via telemedicine is of sufficient and appropriate quality to ensure the accuracy of remote assessment.
- Ensure that information that is collected when a veterinarian practises via telemedicine becomes a part of the medical record. Maintain all applicable aspects of record keeping in accordance with the Professional Practice Standard: Medical Records.
Legislative Authority
Veterinarians Act, R.S.O. 1990
R.R.O. 1990, Reg. 1093: General (Veterinarians Act)
Resources
The following can be found at the College website at cvo.org:
Guide to the Professional Practice Standard: Telemedicine
Professional Practice Standard: Medical Records
Guide to the Professional Practice Standard: Medical Records
Professional Practice Standard: Prescribing a Drug
Guide to the Professional Practice Standard: Prescribing a Drug
Professional Practice Standard: Establishing, Maintaining, and Discontinuing a Veterinarian-Client-Patient Relationship (VCPR)
Guide to the Professional Practice Standard: Establishing, Maintaining, and Discontinuing a Veterinarian-Client-Patient Relationship (VCPR)
Professional Practice Standard: Delegation
Professional Practice Standard: Informed Client Consent
Guide to the Professional Practice Standard: Informed Client Consent
Information Sheet - Apiculture & Bee Medicine
College publications contain practice parameters and standards which should be considered by all Ontario veterinarians in the care of their patients and in the practice of the profession. College publications are developed in consultation with the profession and describe current professional expectations. It is important to note that these College publications may be used by the College or other bodies in determining whether appropriate standards of practice and professional responsibilities have been maintained. The College encourages you to refer to the website (www.cvo.org) to ensure you are referring to the most recent version of any document.