Originally published in the April 2014 issue of Veterinary Practice News Telemedicine is a growing field in veterinary medicine, and professionals in the industry are adding personnel and services to meet that demand. “With increased bandwidth and the increased gravitation toward the smartphone generation, we have seen a more relaxed mentality toward efficient Internet-based communication,” said Eric Lindquist, DVM, Dipl. IVUSS. Dr. Lindquist founded SonoPath.com 2007 to provide a source of sonographic pathology information to veterinarians. “This translates into an easy transition to telemedicine mentality and improved quality of service for all involved.” Dr. Lindquist said SonoPath.com has been growing rapidly in the last few years, and it’s continuing to accelerate. Advancements in technology have paved the way for that growth. The telecommunication and telemedicine processes are “less lumpy” than in the past, when slow bandwidth and limited image quality caused hitches. The technology has improved markedly over the last few years, Lindquist said. He and other experts agree that telemedicine’s growth in veterinary medicine should come as a surprise to no one, because it follows growth on the human medicine side. Growing There are roughly 2,000 human telemedicine networks and counting in the U.S., according to the American Telemedicine Association. Research firm IHS Technology forecasts revenue for telemedicine devices and services to reach $4.5 billion in 2018 worldwide and that the number of patients using these services will hit 7 million in 2018 from 350,000 in 2013. To deal with similar growth on the animal side and stay competitive, SonoPath.com and other companies have refined its services for greater efficiency and to offer higher diagnostic quality. And Sonopath has hired more specialists, said Lindquist, who is president-elect of the International Veterinary Ultrasound Society. “It keeps the process and accuracy of diagnostics tight and less plagued with holes in the image set, patient history, or client communication assuming that more advanced protocols are adopted by the parties involved,” Lindquist said. Nathan Seymour, commercial marketing manager for Idexx Telemedicine Consultants, part of Westbrook, Maine-based Idexx Laboratories, said the company has also seen increased use of its services and has beefed up its offerings to stay competitive. “I believe doctors are realizing that in the modern competitive market, the question of where you spend the majority of your time and, conversely, where you choose not to spend your time is crucial,” Seymour said. “More and more practices send all of their radiographs out as they learn that telemedicine allows doctors to spend more of their time with patients, and with more of them.” Erik Berger, chief operating officer of Asteris Inc., can offer similar stories about growth, but from a different perspective. Asteris doesn’t employ doctors, radiologists or specialists to perform image interpretation. Instead, the firm is contracted to move images and reports from Point A to Point B and help facilitate simplified communication between all parties involved in the telemedicine process “We’ve seen a drastic increase in the number of veterinarians looking for more personal relationships with radiologists, surgeons, internists, neurologists and dental specialists,” Berger said. “What has really grabbed our attention is the amount of referring DVMs looking for better interaction and connectivity to their local referral hospitals.” Problems Some states have cracked down on veterinarians giving online consultations without having a veterinarian-client-patient relationship. In 2013, the Texas Board of Veterinary Examiners began enforcing the state’s Veterinary Licensing Act, which mandates that a veterinarian-client-patient relationship may not be established solely by telephone or electronic means. Experts like Lindquist don’t believe more crackdowns will occur because telemedicine is growing in popularity and usefulness, and as long as a business maintains the quality of its services he believes the government and regulators will stay out of the way. “There will always be a problem if the process is not efficiently implemented with the highest quality. Telemedicine is a remote support and consultation nothing more,” Lindquist said. “The final decision always remains in the hands of the veterinarian with the legal client-patient relationship. Remote support is a bridge and a direct and indirect conversation to help the onsite practitioner head in the right diagnostic and procedural direction for the best interest of the patient.” Lindquist reminds skeptics to keep in mind that telemedicine is no different from what often happens at a clinic. A practitioner may examine a patient and then go into a procedural suite and show a colleague a radiograph to seek another professional opinion. Based on that second opinion, an action will be taken in next room. “We just do this from across the state or across the planet,” Lindquist said. “The human model has an extensive precedent in this regard, so why would veterinary medicine be any different?” Garbage in, Garbage Out The point at which Lindquist sees the process running into trouble is when business operators take a “garbage in garbage out” approach and cut corners, such as using low diagnostic quality imaging. Or a problem can arise if the back half of the process is compromised by a specialist giving a vague report without any direction, assuming there is a solid image set and history provided. “This is where the trouble lies, in that in the first case the specialist is misrepresented and in the second case the client doesn’t see utility in the telemedicine process,” Lindquist said. “This type of activity is truly very rare, but when it occurs bad scenarios develop and that brings on negative attention.” Despite concerns, there’s an overarching need for these services – particularly for professionals in remote locations who don’t have the luxury of being physically near specialists to confer on patients that need immediate attention, Berger said. “While we understand the concerns regarding consultations and diagnoses rendered without direct visitation, we believe that the benefits of veterinary telemedicine far outweigh the negative aspects,” he said. “Veterinarians now have access to some of the most skilled specialists in the field, allowing them to obtain more consistent and accurate diagnoses.” Seymour noted that Idexx fully complies with all veterinary practice act regulations. But he said the market need is a driver of improved quality of goods and services in the sector. “First and foremost, the market expects a quality report,” Seymour said, adding that to better compete companies have invested heavily in quality control and maintain rigorous hiring practices to bring on top radiologists. “We also believe that the overall experience is important, and that means the technology and support have to be top notch.” Innovation Innovation is another area companies need to eye, Seymour said, adding, “We believe that telemedicine is more than just reading radiographs.” Idexx, for instance, has for several years been operating its CardioPet platform, which enables veterinarians to collaborate with a board certified cardiologist by transmitting an ECG over the phone. The company recently added to that system by launching a new CardioPet ECG device, which allows for a transfer online as opposed to over the phone. “This is the first and only simultaneous six-lead device for collaborating with a cardiologist that is DICOM-compliant that we know of,” he said. The device enables practitioners to view and save an ECG file, and then if desired they can instantaneously submit all six leads in a .ecg or DICOM format. “Submission with thoracic radiographs or an echo is now significantly improved, which allows the final report from the cardiologist to be much more detailed,” Seymour said.
