Video chat app for pet owners draws concern from veterinarians

A little more than a year after Ron Hines lost his Texas veterinary license for offering veterinary advice over the Internet, a new Tennessee startup has launched a nationwide mobile app called VetOnDemand, which boasts “comprehensive advice from a licensed, certified veterinarian.”

Although VetOnDemand's entrepreneur ownership team denies that diagnoses are being made through the service, the company's website advertises that clients can consult remotely with a veterinarian for peace of mind, health advice or a second opinion on their veterinarian's diagnosis, treatment or surgical recommendation.

Is it legal?

While the veterinary profession has yet to dip its toe deeply into the debate on telemedicine, some state veterinary boards do have the issue on their radar.

Vic Cook, director of program operations and strategic initiatives at the American Association of Veterinary State Boards, says his organization conducted a poll last year asking if state boards were considering the use of telemedicine for practice across state lines. Results revealed that four states had already addressed telemedicine in their practice acts, nine others were considering it, eight were unsure and 33 had not approached the subject.

VetOnDemand has already garnered attention from the Tennessee Board of Veterinary Medical Examiners. In May 2014, Vet­OnDemand founders Curt and Mason Revelette met with Board Director Lisa Lampley, along with Keith Hodges, assistant general counsel for the Tennessee Department of Health, to discuss their business proposal.

In a letter dated January 2015 addressed to Mason Revelette, Hodges wrote, “Based on information provided to us [in May 2014], Ms. Lamplet and I felt the services being offered through VetOnDemand would constitute the ‘practice of veterinary medicine' … and that those services could only be provided in the context of a veterinarian-client-patient relationship.”

According to the Tennessee veterinary practice act, a veterinarian-client-patient relationship “cannot be established or maintained solely by telephone or other electronic means. Tennessee-licensed veterinarians may only be employed to practice veterinary medicine by other Tennessee-licensed veterinarians or by veterinary facilities operated at all times under the direct medical supervision of a veterinarian. Persons, corporations and other organizations operating veterinary facilities, including mobile clinics, must apply for and receive a premises permit.”

The veterinary board says it received no reply from VetOnDemand after the issuance of the January letter but would not comment on whether an investigation has been launched.

Mason (left) and Curt Revelette, founders of VetOnDemand, own several restaurants in the Nashville area. Photo courtesy of VetOnDemand.Curt Revelette, owner of Vet­OnDemand, says his company tried to reason with the board initially. “We were proactive about reaching out to the state,” he told dvm360, “explaining what we had seen in technology, what we had seen with the numerous human telemedicine companies, and to get some insight from them on what we were wanting to do.”

The problem, as Revelette sees it, is that “the laws are 50 years old” and need to change to accommodate current technology and its impact on medical advances. “We're hoping as we work through this process with the state that they and other states take a good conscious look at what's best for the animals and where we are with technology,” he says.

Is it safe?

There are many reasons to be concerned about what VetOnDemand is doing, and at the top of the list is patient safety, says Ernie Ward, DVM, author, Veterinary Economics Editorial Advisory Board member and founder of Seaside Animal Care in Calabash, North Carolina.

Dr. Ernie WardUnlike human doctors, veterinarians can't ask an animal to describe its symptoms in a video chat, Ward says. They have to rely on the description of the owner. That's why a physical exam is so important; it gives the veterinarian information the owner can't-a subtle flinch of pain on palpation or labored breathing sounds audible only through a stethoscope, for example. “Doing this by proxy gives us one more level of challenge,” Ward says.

But Revelette says VetOnDemand fills a gap for pets whose owners aren't able-or willing-to go to a brick-and-mortar practice for one reason or another. “There are so many common questions that people want to know,” he says. “They currently are not going to a veterinarian to wait an hour or spend a couple hundred dollars for these minor questions, so what they're doing is going to Google, and there's a lot of misinformation out there. Ninety-nine percent of pet parents love this and are excited to get trusted advice from a veterinarian for common questions.”

Revelette says he and his brother, Mason, got the idea for VetOnDemand after a harrowing veterinary visit with their own family pet that turned out to be not entirely necessary. Plus, he argues, many veterinarians are already giving advice via other media, like phones or messaging applications, but VetOnDemand allows them to actually see the animal through a video platform.

“The majority of people say, well I'm not too sure about this bump or scratch; I'll just wait six months,” Revelette says. “That gap is where animals are not getting treatment.”

Here is part of what a veterinarian sees during a call for VetOnDemand. Photo courtesy of VetOnDemand.Revelette says the app is not meant to sideline the veterinary profession, but rather to complement it. “Our goal is not to alienate the vets. We need the vets as partners,” he says. “Our model is saying we need you, vets; we are providing a technology platform to assist you with your business and help you grow your business.”

A new model?

VetOnDemand partner David Victor says the company is not providing diagnoses or treatment but simply providing another platform for veterinarians to connect with their clients.

“There's kind of a gray area in there. Medical advice is forbidden to be given out,” says Victor, adding that veterinarians are not technically employed by VetOnDemand. “We do not give out diagnoses. Our veterinarians are strictly prohibited from saying, ‘This is what's wrong with your animal.'”

The goal of the service, rather, is to provide pet owners with more accurate advice than they might receive from an Internet search. “It's advice from a trusted source. Veterinarians are experts. They know better than anyone else what the best course of action is,” Victor says, adding that veterinarians might recommend vaccination schedules or tips on how to socialize a new puppy. “Veterinarians are going to be able to answer those questions better than Google. If somebody calls in with a question more related to the medical side of an animal's condition, our veterinarians always insist that the pet owner take the animal in to their local veterinarian.”

He says VetOnDemand eventually plans to encourage veterinarians to adopt the service themselves to engage with clients after hours or in times when travel is difficult. “We're really focused on getting the platform in the hands of veterinarians so they can get their patients to reach out to them specifically,” Victor says.

The profession's response

Ward says that after 25 years in practice, he won't even give his own clients advice about their pets over the phone. It's safer, he says, to always see the pet because you never know if the client's description of the animal truly reflects what's going on. And for now, at least, he doesn't believe Vet­OnDemand is within the legal parameters-most states are pretty clear about what constitutes the veterinarian-client-patient relationship.

“I think there's a fine line between advice and diagnosis, advice and treatment recommendations, advice and second opinion,” Ward says. “If we accept this service, then it really does change fundamentally the way the profession will march forward.”

Ward believes state boards need to convene and come up with a clear stance on these new technologies before things get out of hand. Historically, the profession didn't have to define “relationship” so narrowly, he says. But technology has offered new possibilities, and the profession must decide whether these new models are sufficient to adequately care for pets. Even if telemedicine is a service the public is demanding, the profession has the responsibility to advocate for what's in the best interest of the animal, he continues.

“As a profession we need to start this discussion immediately,” Ward says. “If we don't, we're going to be left in the vapor trail. … We need to define for ourselves on a state-by-state level what we will accept for minimum standards. These are murky legal waters.”

Ward says he's also concerned about the reputation of veterinary medicine. “If these things go sour, it makes the whole profession look bad,” he says. “This is uncharted territory. We don't have time to sit back for a year or two. These types of companies take advantage of that, of slow-moving organizations and professions. This is one of those areas where state boards really need to just convene and decide how to act.”

Ward says he's not passing judgment on whether VetOnDemand is good or bad-in fact, if the company could prove patient safety was its top concern, he says he could get behind it. “But the fact that this is moving forward and they have no veterinary experience whatsoever … are veterinarians prepared? And what about transparency for pet owners?” he says.

Here's what the VetOnDemand founders do have for experience: Victor, 28, has a background in technology and owns a company that builds mobile applications. Curt, 33, and Mason Revelette, 28, own several restaurants in Nashville. Mason has also worked in real estate, and Curt has been CEO of an assisted living facility. Despite not having a veterinary background, they say they have seen a need-and a gap in service-in the veterinary world, and they want to give pet owners a tool they want and need.

But what pet owners want and what is best for pet safety might not align, Ward cautions. “Just because a pet owner wants it doesn't mean that it's safe or accurate or sufficient,” he says.

Victor says the company trusts that veterinarians are going to do the right thing when it comes to giving advice over the platform. “We maintain a personal relationship with all the veterinarians we have,” he says. “We are vetting them to make sure these individuals are here for the right reasons.”

Veterinarians and users will also be able to rank one another, and any veterinarians earning just one star will be removed from the platform, Victor says. “There won't be any one-star vets because that's when a red flag goes off for us,” he says. “We are doing our best to make sure we run an extremely tight system.”

On-demand veterinarians

Two veterinarians who are already taking calls for VetOnDemand say they see the service as a benefit to the profession.

Joyce Gerardi, DVM, CVA, owner of Mobile Arthritis Therapy in North Carolina, began taking calls for VetOnDemand in March and says her clients appreciate having access to a veterinarian after hours. “So far it's been favorable. It's a great after-hours service just because then people aren't questioning themselves,” Gerardi says. “If anything it's going to drive people to the right care. If anything it's going to help my colleagues.”

Gerardi says her colleagues have been inquisitive but not opposed to the work she's doing. As far as being in compliance with state practice acts, she says veterinarians must adhere to the law in their own state.

Phil Baxter, DVM, owner of Animal Health Care in Rainbow City, Alabama, also takes calls for VetOnDemand. He says the service is valuable for many clients who are in financial straits and have to weigh taking their animal to the veterinarian against other critical expenses.

As for safety, Baxter says it's not any more difficult to assess the patient over video chat than it is in the clinic. “Can you really get an assessment in the clinic?” he asks, adding that many of his clients can't afford advanced testing and he must rely on visual symptoms, the animal's history and the word of his clients. “I can't go in and run every test in the world. What I was taught was that the test was not to be the basis of diagnosing the disease, it's for confirming the diagnosis.”

But Baxter agrees that the service-like some aspects of a physical practice-may fall into a legal gray area. “It depends on where you draw the line,” he says. “Yes, to a degree we are providing some kind of diagnosis.”

Diagnosis, by definition, is the identification of the nature of an illness or problem. The question is how a veterinarian can assess the severity of a patient over a video chat-or in a clinic-without first making some form of diagnosis.

But Baxter says 80 percent of the health issues in human medicine will resolve on their own, and animals are no different. What he's able to do is offer clients advice on home remedies and provide them with knowledge that will help them care for their animal. Whether a veterinarian prescribes the right or wrong thing in a physical clinic, most animals will get well either way, Baxter says. “Here I can give them some advice, and they can manage their money a little better,” he says.

In terms of the veterinarian-patient-client relationship, Baxter says he sees VetOnDemand as no different from one veterinarian in a multi-veterinarian practice answering an emergency or after-hours call for a colleague. “He doesn't have a patient-client relationship. There's a practice relationship, but not a doctor relationship,” Baxter says.

VetOnDemand is “not a bunch of veterinarians trying to keep people out of clinics,” Baxter says. “It's just an alternative way of determining if there's a need in taking care of the smaller things.”

The VetOnDemand app is free, but the service costs users $2.50 per minute. Seventy percent of that goes to the veterinarian. Revelette says the app has been downloaded 5,500 times since its launch in May, and 4,500 users already have created profiles for the service. Not all of those users have made calls to VetOnDemand yet, he says-the company is averaging about 10 calls per day. VetOnDemand has 32 veterinarians ready to take the calls across 13 states, and Revelette says he's already gotten requests in the United Kingdom and Canada to offer the service there too.

“We're not expanding as fast as possible; we're trying to provide a higher level of care to as many animals as possible-and that's what's going to govern our growth,” Revelette says.

Rachael Zimlich is a freelance writer in Cleveland and a former reporter for dvm360.