1 Aug 2019
Telemedicine has been with us for many years in one form or another, but recent developments have upped the ante for veterinary practices of all shapes and sizes – so be prepared...
Ray Girotti
Job Title
Image © bassemadel / Adobe Stock
Telemedicine means different things to different people. For some, it is still a business to business (B2B; or practice to practice) relationship, centred around advanced imaging. For others, it is the much newer aspect of business to consumer (B2C; or practice to client), be they pets or production animals.
The rapidly growing B2C aspect of telemedicine is the one attracting the most interest – and comments – of late. While electronic consultations and the incorporation of artificial intelligence (AI) is a relatively new feature, production animals vets have been harnessing technology for some time – from telemetry for dairy cattle, to the use of robots and video in aquaculture.
The advent of AI in health care is a real game changer – and we haven’t even got to grips with the understanding or regulation of telemedicine yet. More than 50% of global health care leaders expect an expanding role for AI in monitoring and diagnosis as an aid for clinicians. While we in the veterinary profession lag behind a bit, with technological growth, we should expect the gap to narrow in the near future.
The role of telemedicine in B2B relationships exists primarily to support practices. And while tele-triage and tele-advice are more generally accepted by the profession, we should be prepared for data-driven decision-making to take over from digital diagnosis in the future.
In short, yes. We can all go home now. But realistically, for us to try to stop the flow of telemedicine into our profession is akin to Canute attempting to hold back the tide. It is here, now, and it will only proliferate. That doesn’t mean we can’t regulate it, but to do so, we must try to stay ahead of the curve.
The rapid development of telemedicine, particularly B2C telemedicine, raises a number of significant concerns for the profession. Concerns exist about vested interests from large corporates or pharmaceutical companies, and about the regulation of treatment and prescribing. Both very legitimate concerns.
Considerations include:
As RCVS standards committee chairman Kate Richards termed it, there is a “technological myopia”, which is when we underestimate future developments as they are assessed by current technological capabilities. If we plan to regulate the development of telemedicine based on what it can do now, we risk being left behind by further advancements, such as with AI.
The growth of telemedicine – both B2B, but particularly B2C – will be driven by demands; both from the profession and by clients. Michael Hammer defined the five primary consumer demands as wanting to spend less money, spend less time, have more quality, have more value added and dealing with those that are easier to do business with. Telemedicine addresses a number of – maybe even all – those consumer demands.
As research by the Mayo Clinic has shown, telemedicine consultations can improve the care experience, improve health and reduce costs – the three primary aims of health care providers. Benefits include quick availability to health information from multidisciplinary sources, although the more complex conditions still need direct, hands-on involvement.
As highlighted by the Mayo study, however, major issues still exist regarding the outcomes, how the joined-up approach to telemedicine will operate and how these can all be effectively integrated. The RCVS report on telemedicine highlighted three main issues – the potential role in enhancing existing care models, the inability to effectively diagnose, and client understanding and compliance – as needing addressing.
Other major issues include the expertise of the vets providing telemedicine services and there was a great resistance among most vets to change the rules about prescribing without a physical examination, so there is much on the plate for the regulators. The question is, can they keep up?
There was, however, an acknowledgement about the need to embrace new technologies, and it was acknowledged among professionals that the development of telemedicine brought advantages as well as disadvantages. As a profession, we must be responsive to client needs – be they B2B or B2C.
While the technology exists and clients demand it, a vacuum will be created until someone fills it. There is now a greater availability of data and information, and this is changing the clinical and diagnostic environment we work in.
We must acknowledge external demands exist that will drive the development of telemedicine. These could be from clients, as owners seek an easy form of access for additional reassurance before seeking first-hand consultations (a major driver in the health care market), to people within the profession, as they seek a better work-life balance. Much of the development of telemedicine is driven by manpower shortage and changing patients’ demands in the GP health care sector; this will inevitably spill over.
Owners will come to expect the availability of telemedicine consults. Be behind it, or be left behind by it. If handled correctly it could expand the market through additional segmentation.
Although alarming, telemedicine should not be a threat to conventional practice. The different modes of telemedicine are designed to complement each other, not necessarily compete with each other. Telemedicine should not be designed to replace conventional practice, but to augment it.
Technology has evolved and driven what can now be done in a telemedicine consult – it can allow a patient to see a remote specialist, with the primary care clinician acting as an intermediary, and can cover cardiac and pulmonary auscultation, otoscopy, ophthalmoscopy and many other investigations. It is this joined-up connection between specialists and primary care clinicians that can offer the greatest benefits for patients – and we are already seeing this with ECG telemetry and emergency telemedicine.
So, what does the future of telemedicine hold? Well, no one really knows, and anyone who tells you that he or she does isn’t being entirely straight, or is a genie. What we do know is that telemedicine has a future within our profession and will become an ever-increasing part of how we offer our services.
The offering of telemedicine brings plenty of opportunities and a number of challenges.
Telemedicine offers us the opportunity to address a segment of the market – those who only seek advice from the internet or do not see a vet at all. This is acknowledged as one of the main benefits by the RCVS. As aforementioned, this can help us expand the market.
Other opportunities and benefits for clients and patients include access to specialists where this wasn’t previously possible due to the remoteness of clients or financial restrictions. As one of the main barriers for patients seeing a vet is the issue (perceived or actual) of the client taking his or her pet to the practice, telemedicine gives us the opportunity to bring more pets into direct veterinary care – and that intervention can be done at an earlier stage and, therefore, improve clinical outcomes.
This is, overall, something new for the pet-owning public and will undoubtedly attract more interest. For vets in conventional practice, this can help with accurate triaging and a seamless patient experience.
For vets in practice, telemedicine also brings opportunities and benefits in addition to those aforementioned. Telemedicine can provide specialist consults and guidance, as well as an independent colleague and mentor who is not staring and judging over vets’ shoulders. Due to workload, it can also reduce stress and allow for more cases to be dealt with in-house, which can aid learning and personal development.
But the genie hasn’t created Shangri-La for us, and challenges need to be faced up to and addressed. Much of this stems from the regulatory gaps highlighted earlier. One of the most concerning challenges must be the loss of personal contact, which is so important not only for the vet to get the best possible diagnosis, but also for helping to understand the client better; what his or her needs are and his or her abilities.
The British Veterinary Union is petitioning to address some of its concerns, including the risk to patient health and welfare, a two-tier system of the duty of care, increased client costs through duplication of consultations, and that it will damage the economics of practices and the profession. Some of these smack of protectionism and the Canute approach; others are very legitimate and well-raised.
B2C telemedicine providers have gone on record saying they are there to target simple and low-risk conditions. If telemedicine addresses the simple conditions, where does that leave conventional practice? How will revision treatments be done and paid for if there is not proper accountability of B2C telemedicine companies and they skim off the simpler conditions? Case selection is important as not every case is a suitable candidate for telemedicine
An additional benefit for both owners and practices is that consultations can easily be recorded, although, as noted by the Mayo study, the access and sharing of patient records is essential. This is as true in our profession as it is in human health care.
If marketed correctly, telemedicine could address a market segment previously unreachable by conventional practice and, therefore, expand the market. We saw much of this previously with practices going into pet superstores – many of their clients previously did not visit practice. Vet Futures has identified new technological developments as both an opportunity and a challenge for practice. That is about the only prediction that is undeniably true and doesn’t require a magic lamp.
The genie’s out. Don’t bother trying to squeeze it back in the bottle – just work with it.
