Technology and the ability to care for our patients

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Several trends have been noted in the past several years in veterinary medicine. Two of the biggest are the integration of technology into practice, and most recently, the shortage of veterinary care. Fortunately, advancements in technology have helped combat the shortage of care available to pets and their owners.

The shortage of veterinary care has several contributing causes. The level of care expected by owners is higher than ever. The pandemic also brought about a record number of pets in homes in the United States. Approximately 1 in 5 households acquired a dog or cat during the past 2 years.¹ Unfortunately, veterinary care availability has not been able to match the demand. Shortages in veterinarians and support staff are driven by the dynamic changes, including those associated with the COVID-19 pandemic. This is further complicated by personnel becoming overwhelmed, leading to burnout and compassion fatigue, resulting in a large wave of those leaving the profession. At a recent AVMA conference, 85% of those surveyed relayed that the most important wellness concerns were stress, burnout and compassion fatigue.²

Technology in the veterinary field is rapidly evolving. Advances in medical record systems, invoicing, charge capture, patient care, and monitoring are everchanging. These systems are becoming more efficient and user friendly, resulting in a better patient care and owner experience at our hospitals. Along with this has come the integration of telemedicine, including virtual visits and distant monitoring. This advancement has also been driven over the past couple years by the pandemic and the desire for a higher level of care by owners.

The technology advancements are helping those in the veterinary world keep up with the increased demand for care. Digital medical records are now utilized in approximately 80% of hospitals in the United States.³ Systems such as Cornerstone, ezyVet, and StringSoft allow for access to records from multiple computers within the hospital, portable devices, and remote access sites. This allows for information to be input and accessed from the parking lot, reception areas, exam rooms, offices as well as at home. This improves efficiency for the veterinary team for several reasons, including avoiding the need to record data multiple times, confusion with reading other’s handwriting, and always having the record accessible. Records can be finished at home, which improves the quality of life and quality of records for some veterinary professionals. The time and physical space saved by utilizing digital medical record systems improves the level of care and communication provided to owners and their pets. Some medical record keeping systems also have digital treatment plans. This allows for modifications of the treatment plan from multiple access points.^4,5 It also allows for more reliable charge capture for treatments, services, and inventory items.

Invoicing systems have been forced to improve throughout the pandemic. With many hospitals transitioning to curbside appointments during the pandemic, many of us were forced to improvise to avoid close contact with owners. Many of these practices proved to be of benefit long term, even when we slowly transition back to seeing pets and owners in exam rooms. Estimates can now be efficiently sent and signed by owners using a variety of medical record systems and third-party software entities such as DocuSign. Invoices are paid over the phone or digitally when using credit cards. Third party payment plans such as CareCredit and ScratchPay now have efficient over-the-phone or internet approvals. Pet health insurance companies such as Trupanion have an efficient online system for direct payment to veterinary hospitals.⁶ For others, efficient reimbursement has taken some of the stress away from clients when expensive veterinary bills.

Virtual care is gaining traction in the veterinary world and comes in several different forms. These can be used as a triage system for owners to determine if an in-person visit is necessary, post operative monitoring, hospice care, or in preventative care situations. Visits and follow up can be in the form of video chats (Skype/Zoom), phone conversations, texting, email, and online portal systems. There are benefits and limitations to virtual care. One of the biggest benefits is the avoidance of travel and transportation of pets and the associated stress to owners and pets. There is a large perceived convenience benefit to the owners. Veterinary professionals are able to work from home or outside of traditional office hours to accomplish tasks and communication with owners, improving on efficiency of the hospital while generating income. This can reduce the workload of the team as well as the stress level of clients while caring for their pets. It also allows for less direct contact between staff and clients, which is a concern during the pandemic. The biggest limitation to virtual care is the lack of a physical exam, which remains a vital part of patient care in veterinary medicine. Prior to most virtual care applications, a veterinary client patient relationship must be established. Virtual care must also be documented in records, just as any other care and communication provided to a pet. Guidelines for virtual care have been established by the AVMA and AAHA and can be accessed through their respective websites.^7,8

A growing area of virtual care is virtual monitoring. Devices are allowing the veterinary team to monitor patients from afar. This allows for more precise and rapid monitoring and adjustment in treatments for patients at home or in hospitalized situations. Continuous glucose monitors can be placed non-invasively. These allow for accurate monitoring of blood glucoses without the need for traditional blood glucose curves.⁹ Owners can monitor and record measurements at home using the device and an app. These can then be reported to the veterinary team to assist in adjustments in insulin dosage over time. The monitors can also be used for hospitalized cases. This close monitoring helps with adjustment of insulin frequency, doses, and adjustments in constant rate infusions (CRI) for patients hospitalized for a variety of conditions, including diabetic ketoacidosis.

Wireless TPR monitors are another device used for virtual monitoring. Wireless monitors, such as MeasureON!, can be placed on patients and worn comfortably (Figures 1 and 2). They continuously transmit the patient’s temperature, respiratory rate, and heart rate and can be monitored using an app on a portable device or website. The real time values can be monitored outside of the hospital, allowing for remote monitoring of patients that are hospitalized. The continuous monitoring and display of values reduces the workload on veterinary staff because of less time taken to obtain manual temperature, pulse, respirations (TPRs). Patient care is improved as changes in vitals can be recognized earlier than if only obtained serially. This time saved can be used to improve efficiency of the hospital.

Figure 1. MeasureON! - Pet Health & Vitals Monitoring Device (photo used with permission from VetMeasure.com)

Figure 3. MeasureON! device in use (photo used with permission from VetMeasure.com)

The current limited availability of veterinary care in the US is frustrating for owners and veterinary professionals. However, progressive technology advances have assisted us in providing care as efficiently and thoroughly as possible.

References

1. New ASPCA survey shows overwhelming majority of dogs and cats acquired during the pandemic are still in their homes. May 2021. Accessed June 23, 2022. https://www.aspca.org/about-us/press-releases/new-aspca-survey-shows-overwhelming-majority-dogs-and-cats-acquired-during
2. Carr GD. Veterinarians and potentially impairing illness. Insight Magazine; 2012 Sep-Oct.
3. Krone LM, Brown CM, Lindenmayer JM. Survey of electronic veterinary medical record adoption and use by independent small animal veterinary medical practices in Massachusetts. J Am Vet Med Assoc. 2014;245(3):324-332. doi:10.2460/javma.245.3.324
4. ezyVet. Accessed June 23, 2022. https://www.ezyvet.com/
5. StringSoft. Accessed June 23, 2022. https://www.stringsoft.com/
6. Trupanion. Accessed June 23, 2022. https://trupanion.com/
7. Telehealth & telemedicine in veterinary practice. American Veterinary Medical Association. Accessed June 23, 2022. https://www.avma.org/resources-tools/animal-health-and-welfare/telehealth-telemedicine-veterinary-practice
8. 2021 AAHA/AVMA Telehealth Guidelines for Small-Animal Practice. American Animal Hospital Association. Accessed June 23, 2022. https://www.aaha.org/aaha-guidelines/telehealth-guidelines/telehealth-home/
9. Del Baldo F, Canton C, Testa S, et al. Comparison between a flash glucose monitoring system and a portable blood glucose meter for monitoring dogs with diabetes mellitus. J Vet Intern Med. 2020;34(6):2296-2305. doi:10.1111/jvim.15930