...continued from previous page It may be legal for companies to not facilitate record sharing, but is it ethical? Consider the need to access records during an emergency situation or when pet owners travel with pets. Sharing records There is no greater service we can give a pet owner than to ensure their pets’ records are available and accessible when they need it the most (e.g. during an emergency when your practice is closed or when they are traveling). Even helping pet parents with a newly adopted pet is easier when the shelter can share records with your practice,18 yet there are shelter software companies unwilling to connect with platforms that could facilitate this. It is legal for these software companies to not expose connections to other applications, but is it ethical to block pet data from a standardized app accessible to the pet parent? There are many types of data agreements between companies that “control” the veterinarian’s or shelter’s data, and if they do create a link (called application programming interface [API]), it is rarely free and often accompanied by rigid data control. In other words, the company is, in fact, restricting access to a veterinarian’s or shelter’s data! An ethical solution would be to create secure and open APIs with veterinary “ethically aligned” agreements, which would dramatically improve the access to innovation by independent veterinarians. Ethical proposals for record sharing (interoperability) The veterinary profession could develop a stance on open and secure APIs that are aligned with ethical standards on data use and privacy. Just as veterinary digital imaging communications in medicine (DICOM) gave veterinarians freedom of choice by allowing digital radiographs to be transmitted to the radiology group providing the best customer experience, open API would give veterinarians freedom to pick the systems, platforms, and apps that best fit their practice and clients. Further, these APIs allow practitioners to more easily change technology solutions if the original choice did not conform to the veterinary ethical norm. A second idea that may help both pet parents and veterinarians is the adoption of a standardized digital companion animal clinical summary (DCACS), which could be available to platforms and apps. Further, it is updated through extraction from veterinary PIMS, so the consumer could have current information about their pet’s health status when they need it. This standardized data set could include microchip ID, vaccinations, allergies to products, active clinical conditions, pet emotional record,24 current medication list, etc. The standardized DCACS could be administered by a coalition promoting standards that are best for the profession and consumers. One proposal is to form an interdisciplinary coalition made up of representatives from national veterinary organizations and others to develop and evolve this summary, and adopt standards that make sense and align with our ethical vision of veterinary medicine. A task force on interoperability has been formed recently by AVI, which could be broadened to include many other veterinary organizations. The field of veterinary clinical informatics is a rapidly evolving science that blends information technology, communications, social and behavioral science, and veterinary medicine to improve the quality and safety of patient care.21 The ethics of televeterinary consultations Real-time (live audio/visual) and asynchronous (journaling, texting, email) televeterinary consults shift VCPR from the current norm where most of the interaction takes place in an exam room to engagement in the client’s home using technology to communicate. Imagine a future where 80 percent of veterinary medicine is conducted remotely with virtual care, such as telehealth, telemedicine, and e-commerce products, including auto-shipment of medication or preventive care products. In this future, many diagnostics are performed in the clients’ home as well. Proper planning can help practices (whether independent or corporate) prepare for this change and help veterinary teams adapt and transition. This planning must include carefully reviewing and creating the ethical norms, as well as understanding what legal boundaries also are due for a change. Having an ethical framework for choosing telemedicine technology gives veterinarians the confidence to move forward in selecting technology aligned with best practices to ensure pet parents have the right digital advisors while making important health-care decisions for their pets. Become an “ethical digital practice” Millennial pet owners are using their digital experience with technology as the basis for their choice of veterinarian. As the connected digital experience evolves and e-commerce integrates with or replaces our current workflow, veterinarians need to develop a process to select what technologies are ethically aligned with offering a high-quality client and veterinary experience. Collaborating with your PIMS provider is a great way to ensure they are involved and understand the ethical issues related to digital practice. What if veterinarians re-invented their category of business to operate more like Amazon? Apple? Uber? Airbnb? If the re-invention is veterinary-led, it will align with what is best for pet health and happiness. And if veterinarians think about the lifetime care of a pet instead of one office visit at a time, they will also adopt solutions allowing the pet owner to afford and provide better care while ending economic euthanasia—a true ethical revolution! The veterinary profession has dedicated itself to caring for animals and public health through education and training to be the key animal health advisors in the future. However, veterinarians need to move quickly and responsibly to a more digitally connected platform! And the veterinary team is well equipped to help veterinarians do this. Remember, most veterinary technicians are tech savvy and grew up with a smartphone. Envisioning the future When the future can be envisioned, it doesn’t generate as much fear. Many questions can be answered if we decide on the ethical norms discussed in this article as boundaries to ensure a great client experience, as well as better quality outcomes for animal care. We are in a unique position to be able to maintain our influence with clients and use our knowledge and wisdom to help pets if we can define and exert the ethical boundaries for our digital future. Technology solutions can help veterinarians stay engaged with clients, keep pace with medical advancements, and get out in front of the economic tidal wave, as we shift to a new paradigm—a role as a “digital guide” instead of a “hands-on hero” to the pet parent/animal owner. Ethical guidelines ensure we stay authentic and relevant through this paradigm shift. Imagine a future in which a veterinary hospital receives information and dashboards on their patients from data collected at the pet’s home, such as activity, medication compliance, diagnostic test results, genetic test results, and connected device information (e.g. heart rate, respiratory rate, scratching or trembling, and other behavior changes). Alerts that show up in a daily hospital dashboard could help the veterinary team triage these cases to the veterinarian. How much more informed will a veterinarian’s decisions be for each individual animal. Consider how this can ensure clients stay bonded to their veterinary practice and veterinarians remain the trusted advisor in the digital age. Innovations like these should be available to all practices, whether they are part of a large corporate group or an individually owned practice. This is the path we choose now when we consider how data is used for the benefit of the pet and pet parent, and how access to innovation is aligned with the veterinarian’s ethics. Ensure you are well equipped to become prepared for ethical issues and join in the discussion to lead the change with well principled action. Our profession depends on it! Examples of technology that is/will be driven by veterinarians Connected devices Chronic disease management tool Artificial intelligence Genomics Preventive care plans and pet medical insurance Platforms and pet care ecosystems λ Examples of technology that is being driven by pet parents Wearables or connected devices Category apps—plug and play all your client apps into one platform Medication reminders as smartphone banners Daily wellness programs and activity tracking Connection to the non-medical pet care community At-home televeterinary consultation and diagnostics Kerri Marshall, DVM, MBA, is a second-generation veterinarian focused on veterinary innovation. She received her DVM at Washington State University and her MBA at the University of Oregon. After 10 years of private practice and as staff at UC Davis, Dr. Marshall joined the founding management team at Banfield Pet Hospitals. In 2011, she joined Trupanion, leading the development of Trupanion Express and was awarded NAVC’s 2018 Veterinarian Innovator of the Year Award for this invention. Currently, Marshall is chief veterinary officer, board member, and investor at BabelBark, a technology platform connecting pet parents to pet care providers. She can be contacted via email at kerri@babelbark.com. Resources 1 “The Digital Mobile Practice: Connecting to Clients in a New Way,” Kerri Marshall, DVM, MBA , Innovation Symposium, Veterinary Innovator of the Year lecture VMX 2018, Feb 4, 2018, pdf of talk available on request to kerri@babelbark.com 2 “What is Ethics?’ Catherine Gates, CPCU, AU, Society of Chartered Property and Casualty Underwriters 2018. bit.ly/2SApPXf 3 “With merger, Schein, Vets First Choice to amass clinic data: veterinarians worry uncontrolled data flow could undermine profession,” Lisa Wogan, VIN News Service, August 22, 2018. bit.ly/2EhRppc 4 Gartner Customer Experience & Technologies Summit 2017, 10 - 11 May 2017 / London, UK, gtnr.it/2zNdnfT 5 “Welcome to the Experience Economy,” B. Joseph Pine II and James H. Gillmore, Harvard Business Review, 1998. 6 “Rewriting Life: A Vision for Personalized Medicine: Genomics pioneer Leroy Hood says a coming revolution in medicine will bring enormous new opportunities,” Emily Singer, MIT Technology Review, March 9, 2010 7 The Innovators, Walter Isaacson, Simon and Schuster 2014 8 “Practice records hold big promise for veterinary research, Public efforts to harness clinic data lag behind private initiatives,” Lisa Wogan, VIN News Service, August 24, 2018. 9 "”Amazon, Berkshire, JP Morgan Link Up to Form New Health-care Company for Staff,” Zachary Tracer and Hugh Son, Bloomberg, Jan 30, 2018, 9:37 am PST, bloom.bg/2nm7dwQ 10 “Google is using 46 billion data points to predict the medial outcomes of hospital patients,” Dave Gershgorn, The Doctor Is In, Quartz.com January 27, 2018. 11 “Going Mobile: Tech for Connecting with Clients,” Tony McReynolds, AAHA Trends, September 2018, pp43-48. trends.aaha.org 12 “Millennials are Picking Pets over People,” Abha Bhattarai, Washington Post, September 13, 2016. 13 “The Millennial Pet Owner, Wakefield Research, Nathan Richter, 2014. bit.ly/2furptq 14 “The Role of Education in a Knowledge Economy,” Dishapublication article from The Mega Year Book 2016, bit.ly/2QkEE3D 15 “Making the Sharing Economy a Source of Opportunity,” Ricardo Pérez Garrido, Reinventing Higher Education, November 10,2016, bit.ly/2EjV2dW 16 “You are now entering the Experience Economy. Just do it: the experience economy and how we turned our backs on ‘stuff,’” Simon Usborne, The Guardian, May 13, 2017, http://smallbizflo.com/business/entering-experience-economy/ 17 BabelBark Connects Pet Businesses with Pet Owners through Shelters www.petproductnews.com, July 2017, pp37-38, bit.ly/2QwYpUT 18 Personal email from Bruce Truman regarding his view on veterinary ethics and technology. Bruce is an animal health technology consultant, immediate past president and current executive board member of VetPartners (VetPartners.org and on the board of CATalyst council.), bltconsulting.com/ 19 “Who Owns the Pet’s Medical Record?” Kerri Marshall, DVM, MBA, Webinar Discussion by the Bridge Club, June 20, 2018. Recording available on request to Catherine Haskins at Catherine@thebridgeclub.com 20 Veterinary Terminology Services Laboratory (VTSL), a division of the Veterinary Medical Informatics Laboratory at the Virginia-Maryland Regional College of Veterinary Medicine. vtsl.vetmed.vt.edu/ 21 Association for Veterinary Informatics (AVI) avinformatics.org 22 American Animal Hospital Association (AAHA) aaha.org 23 “Dilemmas of Televeterinary Practice,” Rolan Tripp, DVM, CABC, VMX 2019, Society for Veterinary Medical Ethics Track, www.svme.org/ 24 Personal conversations with Ruth Garcia (COO, president of Fear Free Happy Homes) and Marty Becker, DVM (founder), about the future content of a standardized clinical record, fearfreehappyhomes.com 25 Why Patient Engagement Should be Mobile-First, Luma Health eBook 2018, p 1 26 “Milton Friedman told us the answer decades ago—Now it’ll probably be IBM’s Watson,” Tom Worstall, Forbes.com, Innovation section, June 4, 2017,06:42 am, bit.ly/2EeMRjn 27 Exclusive Live Interview with Warren Buffet, chairman and CEO, Berkshire Hathaway, on his 88th birthday. Becky Quick, CNBC’s “Squawk Alley”, 08/30/18. 28 Personal Communication, Peter Alberti, CEO Pet Cause Media, Inc., Outreach Chair, Association for Veterinary Informatics, September 13, 2018. 29 Veterinarian’s Oath: “As a member of the veterinary medical profession, I solemnly swear that I will use my scientific knowledge and skills for the benefit of society. I will strive to promote animal health and welfare, relieve animal suffering, protect the health of the public and environment, and advance comparative medical knowledge. Wikipedia, bit.ly/2QIIySW 30 Matt Russell, CEO DataPoint (an IDEXX company), sent an example of IDEXX wording in their EULA for DataPoint, a company providing data extraction services to veterinarians. September 18, 2018.
