Count radiologist Brian Poteet among those excited to see veterinary telemedicine take steps to outgrow its infancy.
He remembers the hurry-up-and-wait days of courier services and dial-up modems.
“We’ve come light-years from where things were even two to three years ago,” notes Poteet, DVM, Dipl. ACVR, director of radiology and diagnostic imag-ing for Gulf Coast Veterinary Specialists in Houston.
These days, the industry momentum favors digital imaging along with standardized systems and compatible equipment, allowing diagnostic information to be shared more easily and transmitted more quickly. These trends add options for veterinary practitioners, who increasingly want a second set of eyes on their radiographs, cytology, endoscopy, ultrasound and other case information.
Clinics don’t have to lock in with one vendor for all their diagnostic equipment or with one telemedicine service for all their consulting. Advances make it easier for radiologists and other specialists to hang a shingle and as the number of consultants grows, affordability should increase, enticing more veterinarians to seek specialized assistance via telemedicine.
“Over the long term, there’s no question we’ll also see a rise in the standard of care for veterinary medicine,” says Neil Shaw, DVM, Dipl. ACVIM, chief medical officer for BluePearl Veterinary Partners, which operates specialty hospitals in Florida, New York and Kansas City.
“Most general practices operate on an island, without the ability to interact with other clinicians not just on complex but on typical cases. There’s great benefit in having these resources at your fingertips.”
Telemedicine provides a critical link between Dr. Shaw and his BluePearl colleagues, who work at a handful of different hospitals—from Florida Veterinary Specialists and Cancer Treatment Center in Tampa to the Veterinary Specialty and Emergency Center in Kansas City.
Digital imaging and electronic connections allow the offices to share the services of two radiologists, a cardiologist and an ultrasonographer. Distance is no impediment to leveraging these resources, Shaw says.
The group contracts for a Picture Archiving and Communication System (PACS) with DarkHorse Digital Media of Carlsbad, Calif. Such a system allows for storage, retrieval and viewing of digital images and other information.
Technicians can take radiographs in BluePearl’s hospital in Manhattan, upload them to the group’s shared server in seconds and have them read by a specialist in Florida without delay. New images can be viewed alongside archived ones to note changes over time.
“The key is getting someone (in each office) who can capture the images properly,” says Jeff Fox, operations manager for Florida Veterinary Specialists. “There needs to be a comfort level between the technician and the radiologist (or other specialists). They are only as good as the images they have to read.
“For us, it’s worked out well.”
Stat diagnostic results are especially important in critical care cases. Radiologists at telemedicine provider VDIC of Clackamas, Ore., find motivation in cases such as one in which a Labrador retriever named Hope presented with symptoms so severe that hospital staff feared the dog would die.
Then the radiologist discovered an abdominal tumor, which was removed, and eight months later, Hope is doing great.
Such a case illustrates the need not just for speed but for skill and experience in a telemedicine provider. On occasion, Dr. Poteet will get a radiograph from a practitioner who thinks the patient swallowed a ball, until Poteet determines that the problem is just a fluid-filled pylorus.
DICOM – an acronym for Digital Imaging Communications in Medicine – was developed to bring more universality and interoperability to the world of medical imaging equipment, allowing devices and software from different manufacturers to “talk” to each other.
“Sometimes the best service we provide is to eliminate the need for surgery,” says Don Schofield, president of VDIC.
Some veterinarians like to send all their digital X-rays for a radiologist to read—in part, to protect against liability, says Matt Wright, DVM, Dipl. ACVR, president of the independent digital radiology information service Animalinsides.com and of the telemedicine service Insightradiology.net. Dr. Wright practices in San Diego.
Others just seek help with the more complicated cases. The problem, specialists say, is that practitioners who pick and choose may not know what they’re missing.
“The trend is moving toward clinics sending a larger and larger overall percentage of their total caseload,” says Melissa Tugwell, director of sales and marketing for Pet-Rays Veterinary Telemedicine Consultants of The Woodlands, Texas.
The increasing demand for veterinary telemedicine consultants follows a similar trend on the human side, except that veterinarians aren’t required to get radiographs read by a board-certified specialist, as physicians are.
At least in part because they have that choice, veterinarians tend to seek a radiologist with whom they feel a rapport and share a trust, industry experts say.
“The most successful radiologists are those who make a one-to-one association with veterinarians and their practice,” says Bill Hornof, DVM, Dipl. ACVR, chief medical officer for Eklin Medical Systems, an imaging and practice management software company in Santa Clara, Calif.
Relationship-building is one reason Greg Stoutenburgh of Sound Technologies Inc. and DarkHorse Medical Ventures thinks there’s no reason individual radiologists can’t succeed on their own.
“The advent of the Internet and the ease of transferring data have democratized tele-medicine,” he says.
“DICOM helps open us up so you can choose the best telemedicine provider for you.”
DICOM is an acronym for Digital Imaging Communications in Medicine. It was developed to bring more universality and interoperability to the world of medical imaging equipment, allowing devices and software from different manufacturers to “talk” to each other.
Couple DICOM with growing competition in telemedicine and “There is price shopping to be done out there,” Stoutenburgh adds. “The more cases (a practitioner has read), the more you can negotiate the price down.”
PetRays’ Tugwell agrees that digital technology has revolutionized telemedicine. But she adds that telemedicine services still enjoy an advantage over individual providers because they can offer service 24/7/365.
“There’s also an advantage to providing a variety of services, so you don’t have to send to one (provider) for radiology and another for ultrasound,” VDIC’s Schofield says.
So as industry insiders extol the advantages of veterinary telemedicine, do they see any new advances on the horizon?
Schofield sees a day when DICOM standards will not only aid image transfer but will link confidential patient records to those images, so the information will always be together.
It’s another reason to be excited about the future, he says.
“When we’re able to link all of this information, then a full-blown telemedicine system will have come into being.”
Communication Is Closely Grouped Clinics’ True Specialty
At John Thompson’s critical-care clinic, just about every kind of veterinary specialist is next door or around the corner, so there really isn’t a need for consultation via telemedicine.
Because minutes matter and because good information is vital to swift diagnosis, electronic links help drive the success of the six clinics that make up the Advanced Veterinary Specialty Group in Tustin, Calif.
All the specialty clinics—emergency, oncology, dermatology, dental, eye care and imaging—use the same Eklin system and connect to the same database of diagnostic information. So the cancer group can call up MRI results, then text the emergency clinic to look at radiographs of the same patient at the same time.
“I’d say we send or get messages like that at least 30 times a day,” notes Shenandoah Diehl, DVM, Dipl. ACVECC, chief of staff for Advanced Critical Care and Internal Medicine, where Thomspon is the hospital administrator.
Dr. Diehl recalls a case of a dog that presented with an irregular heart rhythm. Group radiologist Rachel Schochet, DVM, MS, Dipl. ACVR, read the X-rays and determined that the dog had a needle in its abdomen.
After the heart rhythm was faxed to a cardiologist, a CT scan showed the needle was poking into the dog’s aorta, so emergency surgery was performed to remove it.
“If we hadn’t had a system that provided all of these links, I’m not sure we could have pulled that dog through,” Diehl says.
The idea of housing multiple specialty groups in the same Orange County building first took shape about nine years ago, Thompson says. Since then, the group has gone from four or five veterinarians and 15 support staff to 25 doctors and 100 staff members.
The clinics have outgrown their original space and are now housed in separate buildings on what is called “the Tustin campus.” If a patient has to travel from one clinic to another, a golf cart equipped with oxygen is available for the trip.
In most cases telemedicine helps make travel unnecessary.
“When I first started here, my very first case was a cat that went to see an oncologist, then to a surgeon, then to get a brain MRI, then to a neurologist,” Diehl recalls. “Now with the tools we have, that cat could stay in one place.
“That means less stress on the patient and on the caregivers. And to me, that means a lot.” — D.A