19 Jan 2022
Vetology founder and chief executive Seth Wallack, and Vetology AI president Eric Goldman discuss developments to concentrate on in companion animal practice, in line with the findings of research into the perceptions and priorities of pet owners.
Image: famveldman / Adobe Stock
Pick up any veterinary magazine and you are likely to see three or four more new technology products being offered.
Faster technology development means more new products being put in front of veterinarians at a faster pace than ever. But which technologies matter, and which technologies are worth buying?
To get to that answer, we must start with the most important question of which products matter.
Some products matter because they solve a hospital problem – and that matters. Some products are a solution looking for a problem to solve – and that doesn’t matter.
Each clinic’s problem matters to it – and if a clinic has a problem, that means it is affecting productivity or efficiency. In fact, any problem we have in business that truly matters affects productivity or efficiency.
Take, for example, a staff problem, a telephone problem, a computer problem, a medicine shortage problem or a car parking problem. All of these problems have one commonality – they affect hospital productivity or efficiency.
But of all these problems, we didn’t mention one: the problem of understanding customer expectations – and that one definitely impacts hospital productivity or efficiency.
If you’re one of the lucky ones who doesn’t have any of the aforementioned typical hospital fires to put out, then consider yourself fortunate because you have the time to look into technologies that can focus on customer expectations.
We don’t talk much about customer expectations in veterinary medicine and not much scientific data is out there. But when we can find it, we need to use it for all it is worth.
For this article, we will use it to determine what technological advances veterinarians should focus on.
In this case, we start with what matters to a pet owner when choosing a veterinary surgeon.
Hawk (2018) surveyed Facebook users to determine the perception and use of telemedicine by veterinarians and owners. The top three concerns of pet owners when interacting with their veterinary clinic were:
This information gives us a very specific place to start when deciding which technologies to evaluate.
The following is a shallow dive into newer technologies relating to one or more of the top three pet owner concerns. The list is by no means an extensive list, nor is the list an endorsement of a product. This list is a starting point.
If you are interested in a review of each category or product, keep an eye out for future articles that include a deeper review.
My (lead author) area of expertise is radiology – and my biggest concern as head of the teleradiology group, Vetology, is reporting efficiencies.
The third owner concern – timely response of information back to pet owners – is definitely front of mind right now with all veterinarians and radiologists when it comes to teleradiology.
We are all feeling the pain of the radiologist shortage, whether on the receiving end of an overwhelming number of teleradiology submissions or on the sending end with longer turnaround times and higher prices.
As veterinary radiology residency programmes are stagnant to declining in number, reporting efficiencies will need to pick up the slack.
Artificial intelligence is likely a veterinary radiologist’s best option for maximising reporting efficiencies and reducing teleradiology turnaround times. Our teleradiology group has created Vetology AI, which uses the latest in artificial intelligence to create and send back to veterinary clinics in minutes virtual radiologist reports that can interpret some of the more challenging or life‑threatening radiographic studies that veterinary surgeons experience on a daily basis.
Vetology AI has shown itself to be in high agreement with board‑certified veterinary radiologists when differentiating heart failure versus lung disease – it has been independently validated as having 92 per cent agreement to a boarded radiologist at a highly regarded speciality hospital in New York.
Another area of current focus is small intestinal obstructions versus enteritis – this solution is currently being independently evaluated by a well-established US‑based veterinary college radiology department on the west coast.
Timely diagnostics results back to the veterinary surgeon are the key for making impactful rapid decisions.
Squarely meeting the number one owner concern, being able to get diagnostic results and moving forward with a treatment plan brings peace of mind to an anxiously awaiting pet’s family, as well as bringing peace of mind to the veterinary surgeon who strives to accurately diagnose and provide the highest level of patient care.
Teleconsulting services exist that provide digital cytology solutions that cuts diagnosis time from days to minutes. Slide transport time is the inefficiency cut-out here, and that is a large part of the time it takes to get a result – based on conversation with our cytopathologist, reviewing case slides and writing a report takes anywhere from 20 to 30 minutes.
Stated another way, if you receive a cytology result back in 24 hours, 97.7 per cent of the time delay is due to transport and slide processing. The cytopathologist was aware of the transport delay and telecytology, but added that he was not aware of any comparison studies between telecytology and direct glass review to confirm any loss in diagnostic acuity.
He did say he reviews glass slides for others who have read telecytology, and in his personal experience he has between 80 per cent and 90 per cent agreement with the telecytologists. However, he also said his agreement is between 80 per cent and 90 per cent with other cytologists when both have read glass slides. When pressed, he did not know whether a subset – or specific subset – of cases exists where the result would be affected by telecytology.
As efficiencies continue to evolve within veterinary medical practice, new technology products – such as those aforementioned – will continue to migrate towards a service mirroring in‑house clinical pathologists or radiologists, or virtual specialists, providing answers in minutes rather than hours or days.
The rapid turnaround time for many of these solutions not only exceeds the owner’s expectations, but, more importantly, improves patient care and time to onset of treatment. Veterinarians being able to confirm their suspicion, or diagnose for a specific illness, through a consult faster than in the past allows the veterinary surgeon to resolve issues sooner.
Specialist diagnostics is not the only area where inefficiencies are being addressed. Reducing inefficiencies in practice are also popping up around ease of scheduling. This is number two on the owners’ top-three list of concerns, and has become even more important during COVID-19.
Examples that have broad acceptance in the UK – and now rolling out in the US – are systems that allow owners to connect with their primary care specialist when they have concerns or general questions about their pet’s health. Primary veterinarians can chat with owners, triage situations and manage the appointment process more effectively. Even putting some of the appointment scheduling in the owners’ hands has met the current “do it yourself” online mentality for internet‑savvy pet owners.
The aforementioned advances in telemedicine, diagnostics and scheduling are ways veterinarians are able to radically reduce the time it takes to provide answers to their clients’ needs, while meeting owners’ top three concerns.
Prior to these types of technologies, clients would have to wait to schedule an appointment, have the veterinarian complete an assessment, and in many cases engage with a specialist to obtain results and help provide answers to owners. The primary care vet may not have access to these services and the owner may have to travel across town – or, in some rural areas, extremely long distances – to get speciality care.
Many of these technologies, such as advanced reading of radiographs, are a game changer in screening for various diseases, and providing quick results that can augment veterinarians’ own decision process and treatment choices.
These solutions also directly address owners’ desires to obtain a fast and accurate diagnosis, followed by earlier time to initiating treatment with their regular veterinarian.
For those who are thinking about – or have already incorporated – telemedicine into your practice, good for you. Sometimes the incorporation of telemedicine happens before hospitals fully understand the current regulations around telemedicine.
The following are definitions and high-level statements about telemedicine law in the UK and EU. If you don’t need this now, print or save it – because we guarantee anyone doing telemedicine will need this information as a reference at some point.
An excellent source for some of this information can be found in an article by Teller and Moberly (2020).
Telehealth: the overarching term that encompasses all uses of technology geared to remotely deliver health information or education. (American Veterinary Medical Association [AVMA] Practice Advisory Panel, 2017).
Mobile health or mHealth: a subcategory of telehealth that employs mobile devices (AVMA Practice Advisory Panel, 2017).
Telemedicine: the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status (AVMA Practice Advisory Panel, 2017).
The use of electronic communication and information technologies to provide clinical health care remotely. Telemedicine extends to the provision of veterinary services by video link, text, instant messaging or telephone, or by any other remote means (RCVS, 2018).
RCVS Code of Professional Conduct for Veterinary Surgeons (RCVS, 2021):
2.35: Specific advice provided remotely, for example via phone or videolink with or without additional physiological data (commonly referred to as telemedicine or telehealth), should only be given to the extent appropriate without a physical examination of the animal. The more specific the advice, the more likely it is that the animal’s owner should be advised to consult a veterinary surgeon in person for a physical examination. In this scenario, the animal owner should be asked to provide the veterinary surgeon carrying out the physical examination with a copy of any advice given remotely.
2.36: Veterinary surgeons should ensure as far as possible that the provision of specific advice provided remotely does not compromise welfare, since the animal has not been examined and there is no ability to monitor the animal.
Federation of Veterinarians of Europe (FVE) European Veterinary Code of Conduct (FVE, 2019):
Veterinarians should utilise digital and emerging technologies to enhance their provision of services as long as they can use these technologies competently, and hold up-to-date knowledge of the animal(s), of the owner and/or of the farm(s)/farmer(s).
FVE strongly believes that examination, diagnosis, recommendations for subsequent action, and the prescription of medicines or surgery are all strongly linked and must be the exclusive preserve of the veterinarian. A diagnosis cannot be made without examination, either physical examination of the animal or investigative examination of samples. A treatment cannot be recommended or a surgical intervention performed without an examination and a diagnosis. Neither can a veterinary prescription be issued without a diagnosis.
