Dr. Aaron Massecar is the vice president of VEGucation at Veterinary Emergency Group. Since completing his Ph.D. in philosophy and habit development, he has focused on bringing evidence-based practices to veterinary education. He and his veterinarian wife are Canadians living in Colorado.Read Articles Written by Aaron Massecar
When a person blinks or a dog scratches his ear and the event isn’t recorded, it’s a moment in time likely to pass unnoticed and unaccounted for, one in an endless series of moments that have no beginning and no end. But what happens when that moment is recorded and someone is paying attention? When a medical professional says, “Hey, you blink more than normal” or “That’s more ear scratching than normal,” we pay attention.
Medical professionals help turn unstructured, isolated moments into something meaningful, something that requires a response. Otitis externa, for example, can be treated. Random ear scratching cannot.
As former IBM executive Jon Iwata shared at the Veterinary Innovation Summit in April, we are awash in unstructured data. Everything from text, images, multimedia, and sensors and devices provide data in new, interesting ways, but the data has little structure. There is no meaning. These isolated moments pass through our virtual space, only to disappear into the digital ether. That is changing.
The evolution of veterinary medicine is delivering not only new devices and wearables that record and preserve data, but also groups of people, like the team at the Pet Insight Project, who structure the information into actionable recommendations. Early onset of osteoarthritis or post-surgical complications in pets can be responded to at greater speed because of the ability to track patient activity levels.
Idexx’s Jon Ayers pointed out that we are moving from an era of reactive medicine toward a proactive approach that moves the point of care upstream to preventive care. The problem, however, is that clients don’t necessarily want to make an appointment and pay the exam fee, only to be told that Fluffy is fine and should come back in 12 months. Unless clients have a deep emotional connection with their veterinarian, they tend to get turned off by that approach. Habitual behavior delays the pet owner’s appearance at a clinic until later in the animal’s life, when an acute situation presents itself.
The most progressive business models today can easily connect veterinarians and clients, whether in an office or through virtual care.
Something to Work On
As we learned at the summit from consumer insights specialist Dr. Kerry O’Hara and the Human Animal Bond Research Institute, a strong connection exists between pet-friendly workplaces and employee engagement and satisfaction. “Having more pet-friendly work environments will contribute to higher employee satisfaction, engagement and recommendations,” Dr. O’Hara said. As more workplaces embrace pet-friendly policies, more veterinary models will work to include wellness visits as an employee benefit, she said.
Of course, expanding the care model extends beyond the work environment. The maturing telehealth field is another way that veterinary professionals can increase access to care.
A year ago, telehealth generated a lot of buzz. Now, the American Veterinary Medical Association has spoken in favor of it through its how-to guide. Although the AVMA still has some hesitancy around diagnosing and prescribing in the absence of a hands-on exam, the American Association of Veterinary State Boards has taken a much bigger step toward advancing the practice of telemedicine.
The AAVSB’s model practice act encourages veterinarians to exercise their professional medical opinion in determining whether the use of telehealth tools is or is not appropriate: “Some situations and patient presentations are appropriate for the utilization of telehealth technologies as a component of, or in lieu of, hands-on medical care, while others are not.” Colorado and Oklahoma have adopted language similar to this, and many more states are considering adopting language as well.
Associations might be slower to move on this front, but consumers and telehealth providers clearly are not. The enormous field of basic triage has emerged as the primary use case for telehealth tools.
Telehealth Delivers Clients
One of the telehealth companies leading the charge, Fuzzy Pet Health and its Dr. Jess Trimble, has demonstrated that the vast majority of client questions surround skin issues, vomiting, pain and behavior, and not the more complex conditions that most veterinarians worry about when they think of telehealth.
People who use telehealth services are more likely to visit the clinic and spend more when they get there. The trick is to measure the client activity and not the transactional cost of providing the service. If a clinic measures how the client is interacting with the clinic throughout the whole experience, then the numbers are pretty clear: Telehealth is a great way to attract and keep clients. If, however, clinics look only at the transactional cost of staffing the service, the return on investment is hard to measure.
The net takeaway: Try offering telehealth to clients and see where you can go, but never compromise your medical standards just because of some new technology.
Telehealth-leading veterinarians like Drs. Trimble and Lori Teller are helping the profession better understand the opportunities available to them — Dr. Trimble through private practice and Dr. Teller through Texas A&M’s telehealth program. Dr. Teller has been hard at work setting up a telehealth service that will benefit practitioners who could use extra guidance from veterinary specialists. Not only is this providing a better standard of care to the entire profession, but student learning outcomes are demonstrably better as well.
Academia is benefiting not only from digital technologies like telehealth but also from digital imaging and virtual reality. New staining techniques pioneered by people such as Dr. Scott Echols of Scarlet Imaging are demonstrating previously unknown vasculature. Michael Morehead’s work with virtual reality at his company, syGlass, is leading to better learning outcomes because it enables greater spatial awareness.
Peering Into the Future
If someone was looking for hype at the summit, then Dr. Daniel Kraft from Singularity University didn’t disappoint. Dr. Kraft took us through a wave of emerging technologies in the human health space that demonstrate care is moving from reactive and acute to proactive and preventive. Most of the change is spurred by the digitization of health data. Through capturing mechanisms like wearables, ingestibles and implantables, the health field is taking unstructured data and producing actionable insights that encourage proactive choices and better long-term health outcomes.
This pace of growth is exponential, not linear. Take, for example, sensors. Originally, sensors collected information that had to be gathered into massive databases and exposed to machine-learning algorithms and comparative analyses with previous data sets, and then formed into meaningful interpretations that provided insight into future behavioral modifications. Then along came sensors that immediately uploaded data to the web for easier access and distribution to those other data sets.
Those sensors have incorporated passive data gathering, aggregation and meaningful interpretation, with actionable insights, into onboard computer chips. We can then take any part of unhealthy behavior, quantify it and provide corrective action at the moment of occurrence rather than through protracted displays of negligent behavior.
Do-It-All Medical Devices
The pet wearables market shows no signs of slowing. As well, the spillover from the digital human doctor’s bag is creating more point-of-care and in-home diagnostics that empower owners to make better, more-informed choices for their animals.
What happens when blood pressure devices, blood glucose meters, otoscopes and dermatoscopes are drop-shipped by Amazon within an hour and all that information is made available to the veterinary professional for an informed opinion? Or what if these medical devices contain internal diagnostics that are equal to or better than a boarded specialist’s ability to diagnose?
The take-home message here is not that technology will replace MDs and DVMs. Medical professionals will always have a role, but their role is changing.
Artificial intelligence and other digital tools won’t replace a veterinarian, but they will replace a practitioner who doesn’t use them.