The coronavirus pandemic, as we know, has changed the way that people interact with their doctors and their veterinarians. There is a need to keep social distance and minimise physical contact. Telemedicine allows this to happen and has been found to have real advantanges (see Aaron Smiley’s recommendations below) beyond this initial reasons for its introduction in some clinics. Although it was around before coronavirus but has exapanded rapidly since the outbreak.
A wider term that is sometimes used is telehealth but there a difference (see below). It is highly likely that telemedicine is here to stay and grow. It actually allows for a more efficient processing and treatment of patients both human and animal. Clearly, however, there’s a lot that you cannot do with telemedicine because there has to be physical contact in most cases of diagnosis and treatment.
However, there is a great advantage in the initial contact with a veterinarian to be via telemedicine because it avoids stress both for the client and the patient. Telemedicine is also highly efficient for triage. It allows a veterinarian to assess the matter initially and decide whether it needs prioritising and whether it is urgent and how best to proceed.
The conventional way to see a veterinarian is to book an appointment and take your pet to the clinic. That’s the default position and it accounts for nearly all appointments. Many of these appointments, it is argued, do not necessarily require the physical presence of the patient and the client. Therefore, on these occasions, both are put through unnecessary stress. The introduction of telemedicine is arguably a positive spin-off and a beneficial consequence of the coronavirus pandemic of which there are others, incidentally. However there has to be caution as telemedicine exposes vets to negligence. If they can’t diagnose as accurately they may make more mistakes. I am sure they are dealing with this potential weakness.
Telemedicine is progressing in other areas such as wearable devices which can transmit data back to the clinic on a continuous basis. I’m referring to diabetic cats wearing a Freestyle Libre device which monitors blood glucose levels continuously.
There also may be advantages to triaging via telemedicine. It allows the client, the pet’s owner, to perhaps use Apple’s FaceTime or some other visual online interaction with their veterinarian, which arguably allows for a more relaxed and enlightening engagement.
I know, with respect to doctors and humans, that telemedicine is successful. Retrospectively it is surprising that it was not introduced before the coronavirus pandemic forced it upon doctors surgeries. Often, people can avoid visiting doctors’ surgeries or veterinarians’ clinics yet still receive high quality veterinary care. This is clearly advantageous to all parties. It also means that veterinarians might be able to speed up the service and “process” more clients throughout the day. This might make veterinary clinics more profitable.
During the pandemic there have been some difficult moments, however, in handing over companion animals outside the clinic. It’s stressful to do that because you say goodbye to a family member under uncertain circumstances. As the medical profession is getting a hold of the coronavirus and dealing with it more effectively I would expect such handovers to be made redundant.
I would also expect that if and when a vaccine is available to the citizens of the world, that telemedicine will remain as a standard process at least with respect to triage as it makes the delivery of medical services more efficient and helps provide a better service to clients and patients.
Telemedicine versus telehealth
Although telemedicine and telehealth are sometimes used interchangeably, I am told that they are different in their scope in that telemedicine describes remote clinical services concerning diagnosis and monitoring while telehealth also includes preventative, promotive and curative care delivery.
A British healthcare company, Babylon Health, working with colleagues at UCL, have created a computer program which is able a diagnose illnesses with a higher success rate than doctors. In 1,671 tests, the programme correctly diagnosed a disease seventy-seven percent of the time compared with seventy-one percent by doctors. Artificial intelligence can outclass people in the fields of radiography and mammography. The computer works on correlation but not causation. This may be a flaw. The achievement of this program is reported in the journal Nature Communications.
There is a business in Cambridge, UK, VetCT which provides “a better quality of reporting service for referral clinics and specialist vets”. They run the VetCT Telemedicine Hospital. As I understand it, they provide services such as CT scans, MRI and x-rays, which can then be disseminated via Internet which speeds up the service. This is clearly a growing industry.
The coronavirus pandemic has dramatically speeded up innovation in respect of the provision of healthcare remotely and through using advanced diagnostic tools.
Dr. Aaron Smiley DVM manages two veterinary practices in Indiana, Devonshire Veterinary Clinic in Anderson and Geist Station Animal Hospital in Indianapolis. He has embraced telemedicine and found that it works well. He implemented a telemedicine app into his practice and as a result, he says, his clients are more satisfied and he believes that he can provide a higher level of care to more animals. He urges other veterinarians to try telemedicine and is convinced that it can improve patient outcomes.
He also says that it is beneficial to veterinarians because it helps minimise burnout and allows veterinarians to charge where previously they were unable to charge (as I understand it). This may be because the app has a built-in charging service which kicks in automatically when used by the client. It seems that the software helps to bypass the difficulties of imposing a charge of clients when for example contacted out of business hours.
Telemedicine streamlines communication with patients and makes it easier for clients to interact with a veterinary clinic after hours which increases revenue for the practice.
Telemedicine apps also help to reinforce and strengthen the relationship between client and veterinarian. It allows clients to reach their veterinarian more quickly and with greater ease. Communication is more direct and easier because clients can ask questions and receive immediate answers via the app. It saves time and effort. It avoids a trip to the clinic which might be unnecessary.
In America, the AVMA have developed guidelines for telehealth. There are certain potential weaknesses such as confidentiality and privacy. We know that there is a burgeoning hacking problem globally. Clearly these guidelines are intended to minimise the potential for being hacked and allowing details to be stolen.