The Ontario Experience: Current State of Telemedicine in Ontario

Hi, this is Mark Cushing and welcome to the fourth episode of Policy Off Leash with the VVCA, giving you a chance to dive into the issues in some detail involving telemedicine, to guide you in making decisions in your own practices.

Today we’re going to talk about the most important topic in telemedicine. Ontario, the largest province in Canada. If you called it a state, it would be the fifth largest state in the United States. Ontario has 15 million people; it is a major jurisdiction and Toronto is one of the world’s greatest cities.

So, what’s the fuss about Ontario when it comes to telemedicine? In 2018, Ontario legalized the creation of a VCPR, veterinary client patient relationship, through telemedicine. By doing that, Ontario became a living laboratory for us down here in the states to learn from. All the questions people have about telemedicine, the fears people have or skepticism that it might be bad medicine or somehow not good for the pet or the veterinarian – we now have a chance to look at a very sophisticated place right above Detroit, Michigan and they’ve had it now for two and a half years.

The Veterinary Virtual Care Association, the VVCA, reached out officially to the executive director of the Ontario Veterinary Medical Association. Canada has VMAs for each province just like the United States does for each state. Doug Raven, the Executive Director of the Ontario VMA; he is very close to his work with many states in America regarding issues concerning veterinary practices. We asked him if it would be possible for him to create a summary that the VVCA could supply to all the state VMAs, all the state veterinary medical boards, and the AVMA that summarizes what happened in Ontario. If we have a place like Ontario with a population of 15 million people that has tried this, why wouldn’t we want to learn from it?

What I’m going to do is go through what we learned and then we’re going to post [the report] on our website which you can take a look at (VVCA.org) and you can read for yourself. In June of 2018, Ontario legalized the creation of a VCPR by telemedicine; like many states on the human side, they did not allow you to prescribe with telemedicine only. You could create the relationship, but you could not prescribe. They also gave a reasonable word of caution to veterinarians: if you feel like you cannot get enough information via telemedicine, then go ahead and of course conduct a physical exam.

When COVID-19 hit Ontario – and at the same time, the United States – they had to adjust. Ontario tightened down very strictly on in-person visits to clinics, but they made it clear that telemedicine was to be used and encouraged. They also made an exception that during the COVID period you can prescribe medications through a telemedicine VCPR. It has been used extensively in Ontario during COVID, which, as of November 9^th, is now approaching its eighth month.

The Ontario VMA has made it a practice to conduct surveys and find out how things are working in the field. Within two months of practices being restricted, almost 90% of veterinarians in Ontario were using telemedicine. 68% – more than two-thirds – used it to triage new cases. 56% used it to prescribe, particularly for flea, tick, and heart medication. More than half of the veterinarians in Ontario made the adjustment of prescribing, but nearly 90% were using telemedicine once COVID kicked in.

Of those that use telemedicine, 83% use a telephone, 12% use Zoom (which seems like where we all live these days), 8% use free video or phone chat service through smartphones, and only 11% use a dedicated veterinary telemedicine app. In July of this year, like many states in the in the US, the restrictions on veterinary practices were relaxed in Ontario. Vets were no longer required to use telemedicine if they didn’t want to. Since then, 81% – 8 out of every 10 veterinarians in Ontario – are still using telemedicine. A question that comes up often when discussing telemedicine and the VCPR is, “Have animals been harmed or killed due to the legalization of telemedicine and VCPRs?”

If in fact telemedicine harms animals, as some speculate that it will, we can look at the laboratory we have up north and see what the evidence is. Ontario has a veterinary medical board that governs all veterinarians the same way that the United States does. It is called the CVO or the College of Veterinarians, Ontario. We reached out to the Executive Director of the CVO in the summer of 2020 and asked if there has been any complaints filed with the board that there was harm or death to a pet or an animal in Ontario due to a veterinarian utilizing telemedicine in the last two years. The answer is zero. Not one complaint even filed, let alone needing to be investigated.

Ontario is going to decide next June if they want to continue allowing prescriptions to be provided by a veterinarian through a telemedicine VCPR; we will see what they decide. Their indication was that they will make that decision based upon the experience and the learning they have from veterinarians in Ontario. Look at the VVCA.org website, read for yourself what the experience was in Ontario. Hopefully, it will help you reach your own judgment about whether telemedicine is safe and a good idea for veterinarians.

Thanks for your interest and I look forward to talking to you next week about what vet techs or vet nurses can do here in the states when it comes to telemedicine. Thank you.

If you want more information or even more fun to engage in an extended conversation with your colleagues about these issues, go to the Veterinary Virtual Care Association or VVCA.org website where our 3,600-member strong organization is engaging on all topics that concern telemedicine and virtual care for veterinary practices. Not just limited to the policies I’m discussing, but how to use it best, how to implement it, how to train staff, what are the proper roles for all the staff members, and how pet owners have reacted to it. We’ll see you next week, thanks.