Originally published in the October 2015 issue of Veterinary Practice News. Enjoyed this article? Then subscribe today! Veterinarians today expect sophisticated diagnostic technology that gets results quickly, those who sell the technology say. Jane Robertson, DVM, Dipl. ACVIM, director of medical affairs at Idexx Laboratories Inc. of Westbrook, Maine, said most practitioners are accustomed to collecting a pet’s blood sample for in-office and reference laboratory testing and quickly getting results. “The modern veterinarian wants the best for her clients and pets, and as a result, relies heavily on sophisticated diagnostic testing and technology capable of quickly and accurately identifying health conditions,” Dr. Robertson said. In-clinic testing, in particular, continues to gain popularity because it enables veterinarians to provide real-time care, experts like Robertson say. Robertson pointed out two products that build on this standard practice: Idexx’s Total T4 Test, which enables in-clinic thyroid testing by adding the test to existing panels, and its Symmetric dimethylarginine (SDMA) test, a kidney test that permits earlier diagnosis of kidney disease in dogs and cats than existing methods. “The classic clinical signs of hyperthyroidism in cats include weight loss, increased appetite, drinking and urinating, increased activity, restlessness and vocalization, vomiting, and unkempt hair coat,” she said. “Hypothyroidism, common in dogs, can cause weight gain, lethargy and dermatological problems. However, clinical signs for both these conditions often occur late in the disease and can be indistinguishable from other diseases.” Pros and Cons of In-House Diagnostic Equipment Robertson said having access to these results in-house creates an opportunity for more face-to-face client conversations, which can influence clients’ perceptions of value and loyalty, and how well a clinic cares for their pets. Accuracy, speed, price and ease-of-use are, of course, top considerations when purchasing a new in-clinic analyzer. But practitioners should be aware of other important considerations, Robertson said. “Because hemolysis, lipemia and icterus are common interfering substances in veterinary samples, it is important to know how well the analyzer copes with these challenges,” Robertson said. The level of customer support should also be a factor, she said, and while most companies offer technical support, it’s good to know whether it’s available 24/7. Another must consideration is connectivity. An analyzer should “bi-directionally communicate” with the practice management software so tests can be selected from the examination room and results automatically downloaded into the patient record, Robertson said. Perhaps most importantly, the menu of tests available to be performed on the analyzer should be considered, Robertson said. “Many blood analyzers are imported from the human market and may not offer important tests that are pertinent for use with veterinary species,” Robertson said. “For example, they may not include day-to-day tests like urine protein: creatinine, fructosamine, reticulocytes and total T4.” Andrew J. Rosenfeld, DVM, Dipl. ABVP, medical director of Abaxis Global Diagnostics in Union City, Calif., also sees the potential of in-house point of care technology. “Clinicians now have the ability to evaluate organ function, electrolytes, complete blood count, blood gas, and specific infectious components within minutes of the patient coming into the office,” Dr. Rosenfeld said. “This allows for quick diagnosis and treatment of the patient. Earlier evaluation allows the veterinarian to treat more quickly and effectively, reducing client expense and increasing success in treatment.” Point-of-care clinical diagnostics can also be a profit center for a clinic or veterinary hospital. The ability for a veterinarian to perform quality diagnostics while a patient is still in the clinic can increase a client’s perception of value, maximize the time a practitioner spends with a client and helps increase client compliance for other diagnostics and treatment that may be necessary, Rosenfeld added. “All of these elements help to increase hospital income while utilizing the veterinarian’s time to practice medicine,” Rosenfeld said. Andrew W. Schultz Jr., director of business development for Midmark Animal Health of Dayton, Ohio, sees patient history and tracking as among the biggest benefits of advancing diagnostic technology. He formerly was the company’s director of monitoring and critical care. Baseline “Just like with humans, baselining and monitoring trends in blood pressure from year to year is an important tool that can help track changes in systemic health, and provide an early warning of underlying disease states, especially in mature, senior and geriatric patients,” said Schultz. Midmark’s Cardell non-invasive diagnostic blood pressure monitors now incorporate a screening mode, which takes five consecutive readings, discards the outlier and delivers an average, Schultz said. “This hands-free indirect method is simpler to use than Doppler, gentler on the patient and less prone to user error,” Schultz said. Not only has technology gone digital, it’s gone lighter, quicker and mobile. Paul Ulbrich, CEO of Vmed Technology in Mill Creek, Wash. is high on this trend. “More veterinarians are now routinely using tablets in their clinics for ready access to patient information and to quickly update patient records,” Ulbrich said. Vmed Technology bundles its wireless ECG and surgical monitors with a Windows tablet for mobile display for patient monitoring in surgery and recovery and for ECG diagnoses. “This allows the user to monitor patients from anywhere in the clinic with a tablet,” Ulbrich said. This is a trend he sees growing on into the future with each year’s new graduating classes of veterinarians. “Digital products will increase in demand as more of the vet populations become computer savvy as the population of younger vets grows as a percentage of the total population,” Ulbrich said. Heska Corp. of Loveland, Colo., recently brought to market its new Element i Immunodiagnostic Analyzer. The product enables in-clinic testing and screening for health concerns such as thyroid disorders, Cushing's disease and Addison's disease. The bench-top analyzer delivers immunoassay testing, including Total T4, Cortisol and TSH testing. The Element i platform is designed to deliver results in under 10 minutes. Technological changes may not be the only driver of diagnostic advances in veterinary medicine. Midmark’s Schultz sees a tie-in between advances in diagnostic testing and the growing interest in pet insurance, particularly with the proliferation of wellness plans that bring pets into the clinic more often for checkups. How Pet Insurance Will Come Into Play As the focus of veterinary medicine shifts more to wellness and preventive medicine, testing, such as blood pressure screenings, will become a routine part of semi-annual checkups, Schultz said. “Pet insurance providers will look at reimbursement for these screenings as a way to reduce the long-term cost of providing health care because diagnosing and treating hypertension has been proven to reduce the duration and severity of underlying disease,” Schultz said. Robertson with Idexx views the growing interest in diagnostic equipment as a self-perpetuating trend. For instance, diagnosing hypothyroidism or hyperthyroidism during visits could improve owner compliance by sending the patient home with medication and personalized treatment instructions, as well as providing the opportunity for the recheck visit to be scheduled at the same time, she said. “With the availability of real-time screening for thyroid disease, we may notice an increase in diagnosis and recognition of this disease as well as owner satisfaction, compliance and treatment success,” Robertson said. Abaxis’ Rosenfeld believes that as the technology and interest in these new developments continue evolving, clinical diagnostics will improve dramatically. “Clinicians will be able to test for more infectious disease concerns, chemistry analytes, more in-depth evaluations of complete blood counts, as well as new evolving clinical diagnostics to help the medical team identify disease conditions easier,” Rosenfeld said. “Clinical diagnostic analyzers’ abilities will allow veterinarians to make thorough, well-informed decisions about the patients and treat more effectively than ever.”
