Dr. Adam Little is a Vancouver, British Columbia-based veterinarian and co-founder of GoFetch Health. He is a former associate professor of practice at the Texas A&M College of Veterinary Medicine and Biomedical Sciences. Dr. Little holds a DVM degree from the Ontario Veterinary College and was the first veterinarian to complete the Graduate Studies Program at Singularity University. He is a past board member of the Ontario Veterinary Medical Association and Veterinarians Without Borders.Read Articles Written by Adam Little
Diagnostics are a critical component of patient care, enabling veterinary teams to uncover information that can strengthen or refute a particular direction for diagnosis, treatment and prognosis. Historically, diagnostic devices have been limited to hospital use, a model that limits access and raises the cost for significant portions of the pet-owning public. That’s what the incoming wave of diagnostics digitization is poised to address.
According to Idexx Laboratories, 17.8% of U.S. veterinary clinic visits include bloodwork, a jump from 11% a decade ago. However, the percentage of pets that won’t receive any diagnostic tests remains significantly high, with upward of 30% not getting any care whatsoever. This scenario leads to delayed interventions, worsening outcomes and shorter lifespans.
Despite the accessibility challenges, veterinarians can do more for their patients than ever before. Diverse specialty areas, improvements in clinical care and advanced capabilities like MRIs are pushing the boundaries of veterinary care. Given these newer modalities, we must ask: How do we ensure that segments of the pet-owning public are not priced out of the market and that the baseline levels of care are affordable and accessible?
This is where digitization can be a powerful force in driving down costs, expanding access and improving the quality of care. We can point to several examples in our own lives.
Consider how digitization impacted photography. Many readers likely remember the days of bulky cameras, extra equipment and precious film stock that limited us to a handful of photos on a single roll. The entire experience was predicated on scarcity. Taking pictures was time-consuming and expensive. Today, our smartphone cameras are orders of magnitude better than the top-of-the-line cameras from a decade ago. More importantly, the incremental cost of taking an additional photo is practically zero.
Along with the ability to take an infinite number of photos arise problems and solutions around storing, sharing, filtering and analyzing images. In 2015, The Atlantic shared this startling statistic: Every two minutes, we produce more photos than the total number of photos in existence 150 years ago. This year, humans will take more than 1 trillion photos.
Multiple billion-dollar businesses are based on the foundation of this shift in digitization. As software eats the world, more industries will witness the impact and benefits of digitization.
What does that example have to do with veterinary medicine? We are beginning to witness how digitization is changing the diagnostic landscape. Companies are reimagining how we collaborate with colleagues, empower relationships with owners and drive better patient care. Several real-world examples of this act as early indicators as to where diagnostics might be heading. The most obvious is radiology.
From Analog to Digital
As an analog process, radiology was time-consuming, expensive and scarce. Processing the film required expertise, space and materials. As a result, a moving patient, spoiled film or process error was challenging to fix. It wasn’t just the broken process but all the capabilities an analog diagnostic process stunted. Sharing, analyzing and manipulating information was not feasible. If you needed a second opinion, you packed up the film, shipped it, and then waited for another veterinarian to review it and provide the findings.
Today, digital radiology is ubiquitous. Multiple images are standard, and veterinary teams not only can repeat radiographs easily but also zone in, share findings with colleagues and collaborate across clinics. The digitization of the diagnostic process hasn’t just made things easier, cheaper and more efficient; it’s also changed how veterinarians practice.
New software businesses are sprouting up to support the digitization of radiology. Since the profession lacks enough veterinarians to keep pace with imaging needs, technology is helping to augment the traditional practitioner. Companies like SignalPet and Vetology are using artificial intelligence to offer quicker, cheaper ways to analyze scans. As more radiographs are read, the algorithms continue to improve. Eventually, more tools will be baked into the diagnostic platforms to support improvements in positioning, analysis and treatment recommendations. That’s similar to how smartphone apps allow you to make sophisticated edits to your photos.
We are moving toward a world in which you can take as many scans as you want and have them read instantly by algorithms informed by the veterinary community’s collective experience and intelligence. This isn’t about automating away a role but augmenting the veterinary team with better, quicker information that can be incorporated more rapidly to improve patient care.
Positive Feedback Loops
Embedded intelligence in diagnostic devices is making its way into the fields of cytology and hematology. Companies like Scopio, Idexx, Antech, Heska and others are embedding analysis into their diagnostic equipment. This means that built-in analysis, scoring and interpretation will be delivered with each sample a clinician collects. Furthermore, the positive feedback loop created with each scan and the interpretation will improve everyone’s algorithms and software. In the same way that Tesla is accelerating self-driving technology by leveraging the billions of miles driven by its cars, so too will veterinary diagnostics be advanced.
One of the best examples of this is the evolution of Idexx’s SediVue analyzer, which uses machine vision to identify and classify elements within urine sediment. Since version 1.0 was released, Idexx has contributed over 350 million images to its knowledge base, improving the algorithms for all veterinarians who use the software.
Showing vs. Telling
The idea of diagnostics can be confusing, anxiety-inducing or frustrating to pets owners. “You are going to take my pet to the back of the clinic, poke and prod it to get blood or urine, and then a machine will spit out an answer?” However, with a digital-first experience, a practitioner has new ways to collaborate and share information with the pet owner and empower the client relationship. For example, in diabetic management, veterinary practices are turning to devices like the Freestyle Libra, which offers continuous glucose monitoring. Not only does the device improve convenience and reduce hospital visits, but its data is rich and accessible, helping to reinforce care recommendations.
Many practitioners understand the importance of “showing” diagnostic results to clients rather than just “telling.” Digitization makes it much easier. Whether they share a link to a radiography image, take a video of a particular sample collection or make medical records available online, veterinary teams can collaborate with clients in new ways, increasing the value of those services.
In some cases, diagnostics once limited to hospital use are shifting to the home, allowing our profession to reach more patients even easier. Companies like ClueJay are bringing pet diagnostics to the home. Embark, Wisdom, Base Paws and others are using genetic kits to help pet owners better understand their cats and dogs and give veterinarians a more complete picture. Companies are pairing these capabilities with telemedicine services to provide more immediate and virtual options.
All this is just the beginning. We are at the earliest stages of a shift of where, when and how diagnostics are used. On the human side, we see companies like Apple embed health care into consumer devices. By liberating information and putting the patient at the center, people are empowered to respond and develop a new type of relationship with their health care providers. On the veterinary side, we are sensitive to the same shifts. Will we embrace the opportunities this creates to reinvent our relationships with clients and the care we provide to patients? Even if we are not ready, we might be forced to.
U.S. PATENT 4131919
Electrical engineer Steven J. Sasson, then working for Eastman Kodak Co., is considered the inventor of the first digital still camera. The images captured by the toaster-size device were transferred onto audio-grade tape and viewed on a TV screen. However, they were short-lived. “The first image was taken of a lab technician that was working down the hall from our lab,” Sasson told MegaPixel in a 2012 interview. “That was in early December 1975. I do not have that image. We had no way to store these images and had to reuse the tapes for the experiments.”