Delivering Innovation in Specialist Veterinary Healthcare

 A case study on Virtual Veterinary Specialists

Nuala Summerfield graduated from the Royal (Dick) School of Veterinary Studies and completed a residency in veterinary cardiology at the University of Pennsylvania, USA. She has spent the past 15 years working as a veterinary cardiologist in academia and private practice. Nuala recently created Virtual Veterinary Specialists (VVS), which is a multidisciplinary real-time telemedicine service designed to support and educate vets in general practice.

Times change. Yet, how quickly does change permeate into traditional professions such as the veterinary profession? Will this change mean that veterinary medicine is accessed and delivered differently in the future?

Here’s a scenario that we’ve all experienced:

A vet in general practice decides they need specialist help with a patient. This usually requires referral outside their practice. This decision to refer, or not to refer, is typically based on a number of factors, including how busy the vet is and their experience and knowledge of that particular specialty. Often a phone call is made to a specialist to briefly discuss the case, plug any decision-making gaps and confirm the need for referral.

This traditional referral model works well, is reasonably efficient and ensures the pet receives the specialist care needed. However, many commonly encountered conditions that are typically referred externally should be relatively straightforward to diagnose and manage in a well-equipped first opinion practice, under the guidance of a specialist.

So, with this in mind, here’s a new scenario to consider:

What if during this initial conversation with the specialist, rather than just seeking to assess whether the patient should be referred or not, the latest real-time telemedicine technologies could be used to enable the specialist to access all the diagnostic information that they require to make a fully informed diagnosis and treatment plan. What if this could be done right then and there, without the patient or pet-owner having to leave the vet’s practice? What could be more time efficient and convenient? What if it was so simple to use this service that it could be seamlessly integrated into the normal daily running of the first opinion clinic, enabling vets to seek specialist help and advice for their patients as needed, thus speeding up clinical decision making? Could this scenario become a new alternative for vets wanting to work up their own cases to a higher level in-house?

This was the thought process behind the real-time telemedicine solution Virtual Veterinary Specialists (VVS) and the reason we created it. However, developing a service that attempts to address these questions has been a real voyage of discovery! One challenge has been pulling together the nuts and bolts of a service that meets the necessary stringent regulatory and clinical standard requirements. Clearly having the right technology is pivotal but also, very importantly, so are the people and the relationships. Whereas previously, vets in general practice and in specialty practice mainly communicated about cases, now they have the opportunity to work-up and manage these cases closely together.

Real-time telemedicine involves the use of technology to change the way that first opinion vets can access specialist healthcare for their patients. It empowers vets to upskill and to do more challenging and exciting veterinary medicine in first opinion practice, with the guidance and support of specialist colleagues. Real-time telemedicine services are ideally suited to progressive, forward thinking, first opinion veterinary practices, enabling their vets to learn from working-up their own cases, utilise their own practice infrastructure and share the case revenue, whilst improving patient outcomes and client satisfaction. They provide vets with a unique ‘hands-on’ learning opportunity, not typically associated with external referral.

Real-time telemedicine enables a highly interactive, live, virtual consultation between the vet and specialist. Software integrates seamlessly with diagnostic equipment in the vet’s practice, including webcams, stethoscope, ECG and high resolution medical cameras (e.g. dermascopes, otoscopes, opthalmoscopes), allowing all this important diagnostic information to be shared simultaneously and easily in real-time from the vet’s practice directly to the specialist. The specialist is able to see the patient in high resolution, to hear the patient’s heart and lung sounds in real-time during auscultation and to interpret diagnostics such as the ECG and images from medical cameras and ultrasound in real-time, as the vet records them.

From working closely with our initial veterinary customers, asking for and (very importantly) listening to their valuable feedback and implementing changes accordingly, we are developing into a new service that vets tell us they find ‘invaluable”. It is extremely encouraging to see how these new real-time telemedicine technologies have been welcomed by the vets who we are working with and that they are very willing to embrace new working practices once they experience the benefit to themselves and their clients.

It appears that this method of working is also attractive to specialists, as it offers them flexibility, convenience and the opportunity to teach and to build strong collaborative professional relationships with veterinary colleagues in general practice.

One of the challenges to the successful adoption of any new working practice is that it requires some initial effort, willingness to adapt and the desire for change. A challenge that real-time telemedicine faces is that many vets in first opinion practices are already very busy. Why would they use this type of service when it may be easier to just refer the patient outside of the practice and relinquish the case control? Although this may be the case for some, it is not the case for vets who want this additional way of accessing specialist healthcare for their patients. They understand that by using real-time telemedicine services they are able to capture more of the patient care in-house as well as improve their own clinical knowledge and skills at the same time.

There have been a number of important learning points for us thus far.

The benefits of this alternative delivery model are not obvious until they are obvious. The benefits have to be experienced before they are fully appreciated.

Any shift in working practices can create resistance. VVS is not here to fight this resistance but to work with vets who are willing to embrace this new concept.

The equipment is key. Having equipment that works is important, but is not the only objective. The service as a whole has to be convenient, user friendly, get the results that vets seek and be time efficient.

In summary, the VVS service creates additional variation and choice in the specialist healthcare delivery model and this raises the wider question: “Are we as a profession ready to embrace these new technology-enabled business practices?”

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