Part 1: Transformational technology

Telemedicine and digital connection

When COVID-19 first struck in March 2020, the veterinary profession’s response to the crisis was swift and decisive.

Within days, a rapid response to Government guidelines meant an “emergencies only” edict was issued by the BVA calling on practices across the UK to only remain open for emergency care and urgent cases.

All routine and non-urgent in-practice appointments were scrapped overnight – a move that effectively put a giant firewall between millions of pet owners and their veterinary practices.

But, as the old adage goes, “necessity is the mother of invention”, and almost as quickly as the pandemic emerged, practices up and down the country scrambled to find new ways to keep connected with their client bases.

And for many, this meant taking the plunge into the world of telemedicine and virtual consults, which, at least for the first few months of the pandemic, became vital tools for thousands of practices.

But as Alison Lambert, managing director of veterinary business consultancy Onswitch, explained, while this approach worked well enough when the chips were down, it is far from being an optimal long-term solution.

She said: “We were in the middle of a global pandemic and had to do something – we have to remember that for practices who were put into lockdown, shut down, furloughed people, staff didn’t come in, there had to be something else that enabled animal welfare to be delivered in that moment of extremeness, and I do think that the profession responded well. Whether that was FaceTime, phone calls, video platforms – whatever that was.

“Does the client want it now? Most of them don’t. If it is used in isolation of any prior knowledge or any other knowledge, there are limitations. In the human health care system, the NHS is already reporting patient outcomes being compromised where there hasn’t been face-to-face or clinician-patient access.”

Like hundreds of other practice owners, Jenny Reason at the Bury St Edmunds Veterinary Centre in Suffolk turned to various digital means to stay in touch with clients and deliver veterinary care, and continues to do so even with the worst of the pandemic seemingly over.

Jenny said: “Obviously COVID hit March 2020 and we opened May 2019, so technically speaking we have been operating more in a pandemic than we have been out of a pandemic.

“Right at the start of the pandemic we did do some video consultations and things like that, but I have got to be honest, they were not fun for anyone involved. You’re just relying on owners holding their phone in the right position, using the right position, using the right camera, etc.

“But I think these systems are useful going forward for when you are doing stuff for the owner rather than necessarily for the pet, so discharge, or when they are wanting to send static photos for post-op checks and bits like that, that’s when they can be really useful.

“You can have your initial stuff in the clinic, and then your follow-ups can be a lot more remote. So you don’t have to have them coming in so much for post-op checks – especially simple things like cat spays and things like that; you don’t have to have them coming in for those.

“It is just finding a way that it works for the individual practice and the practice’s clients.”

Jamie Crittall, co-founder of health care compliance technology company Virtual Recall and practice owner, added: “We just haven’t had the opportunity to really look back, assess and take the good bits, the bad bits or whatever, but since March 26 2020, I haven’t stepped foot in my practice and I hear that they are stacked.

“They’re crazy busy – does that make it effective and profitable work? Well, the jury is definitely out on that.

“Communication, I think, has been the most vital element in all of this. In every walk of life. And if you have been able to communicate clearly; in a timely way; in a personal way to your clients, they appreciate it.

“Going forwards, we need to be able to find that happy medium – the new normality in which we can end up working collaboratively with our clients, to gain a better outcome.”

For Greg Dickens, veterinary surgeon and innovation consultant, finding the right tools to facilitate effective communication is the key, now and in the future.

“Communication is the most vital element here”, he said. “What everybody has been talking about when they talk about telemedicine is telecommunication, and everyone has given some version of how getting information from clients and animals is a nightmare.

“We are effectively regulated on our ability to get information out of our patients. That is a clinical skill, but expecting untrained clients to do that makes no sense. Logically, that is not an easy leap. Whereas none of us are taught how to ring up a client and tell them things. That is not a clinical skill; that is not something you have to pass exams to do.

“What I am seeing is tools that aren’t built for getting information out of animals, such as a smart phone camera that are rubbish at it, and that makes sense.

“If we were to combine wearable tech – which is basically client-facing diagnostic tech – with telemedicine, we are likely to have better luck.

“And the tie-in of that tech is likely to happen more and more over the next five years. I believe it will get better, yes I believe it will be more important and, hopefully, the burning pains of telemedicine where nobody could get any good information out of their patients will finish. Or am I being overly optimistic?”

Thom Jenkins struck a more cautious tone and warned that any future developments in this area need to take place in a way that has the needs of a highly stressed workforce at its core.

He said: “In terms of telemedicine, where people are thinking ‘video consults’, we did see an early peak in those at the start [of the pandemic] as people were looking at revenue replacement opportunities, and we have seen some clinics continue to use those very, very well.

“Since then there has been a drop-off in video consults, with a massive uptick in text chat and file sharing collaboration. So this is not about digitally replacing clinics, it is about digitally augmenting them.

“But I think that people aren’t looking for futurism right now. I think they are looking for pragmatism. No one is looking for one more thing for the sake of having one more thing to do.

“We need to be careful because any new technology is going to be looked through that lens, maybe slightly cynically – ‘Is this one more reason I am not going to get my lunch break?’; ‘Is this one more reason I am not going to get home on time?’.

“So I think any innovation, especially right now, needs to have extreme empathy with the position that veterinary teams are in, and I think it is very hard to get people excited when people say ‘look what more you could do for your patients; look what more you could do for your customers’.

“I think we must focus on need fulfilment for veterinary teams, so giving them the right tools to feel like they are not having to sacrifice more than they can to be in this profession and service the needs they are already being confronted with, I think, is the immediate future at least.”

For non-vet Jack Peploe, the way the profession responded and adapted to new technologies in the wake of COVID was impressive, but he clearly feels time now needs to be taken to reflect on what worked and what didn’t.

He said: “The creativity of the profession is amazing – at the start of the pandemic the stuff these vets did was just incredible.

“It was really good to see, but in some cases it was ‘How am I going to get myself out of this predicament right now?’ and it wasn’t really a thought about what is the right solution and what am I trying to solve, and so you saw a rush of integrations of solutions.

“Thankfully, you have got very intuitive platforms like PetsApp that have very much helped the situation, but for many it was very much a rushed decision and I don’t think sometimes that a lot of practices have had the chance to sit back and look and decide how can they make this better?’.

“If things are planned and structured in the right way, and done properly, it can be done really, really well.”

Wearables and other advances

In recent decades there has been an increased focus placed on preventive health care across both the human and the animal health sectors.

This approach takes many forms, but one aspect is the collecting of health and movement data directly from animals using wearable technologies capable of automatically gathering and storing that information.

For some years such technologies have been in widespread use within the farming sector to monitor herd and flock health, and our panel discussed the significance of their increased use to protect the health of the UK’s pets, too.

Alison believes the companion animal sector can learn a great deal from the way these technologies are used with production animals.

She said: “If we extend this beyond pet and look at farm production, and the role of data; big data – at herd level – and the way the farm production guys have managed optimising health outcomes, there is a different priority and there is a different revenue channel associated with getting that better.

“So I think the farm guys can teach the small animal guys quite a lot about the bigger picture as they are ahead of us in the companion animal sector.

“This is all about portability; movement; dynamic populations. People move houses and homes, and clinics, but one of the constancies is the need to know what’s wrong with a dog when it’s hit by a truck, for example. The means to get this data has got to be attached to the dog somehow and that’s not wearable tech, that’s embedded tech.”

Greg added: “I think a lot of what we call in the profession wearable tech, we should be talking about client-facing tech. It doesn’t matter where it is in the home or the farm, or wherever. It’s not about wearability, it is about client-facing tech use – normally for gathering data; sometimes for delivering treatment. It should be an extension of the practice, in the home.

“In my house I have a Wi-Fi router, a smart doorbell and a security camera that can see in infrared – it would not take much software, maybe a little firmware, to allow that Wi-Fi monitor to tell me how often the cat walks around the house just by the change in reflections, for the smart doorbell to give me a quick look at the gate when it does so and for the security camera to give me a rough look at its temperature.

“All you then have to do is link that to a way to monetise – even if it is only a tiny amount of money – the ability to say ‘your pet needs to be seen, please bring it in’.”

Jack made the point that a general lack of education in the veterinary sector about the capabilities of technologies (both old and new) can often slow the rate of development, and prevent practices making the most of the opportunities.

He said: “I think this all comes back to the point that it is the lack of education, training and enablement of all these platforms.

“If we take most practices within the country, they’re going to struggle to do these things, and that is why they need to have partners to work with them and digitally enable them with their technologies, and allow them to get the most from their platforms.

“For example, I think 80 per cent of practice management systems within the UK are server-based, which is mental in my eyes; that is bonkers, but it is because no one is having a chance to be able to review these things.

“It comes down to all these types of technologies – no one is going to see the benefit if no one comes out and actually tries to educate them and, again, enable the profession; that’s what it comes down to in my opinion.”

There are, of course, technologies that are still some way off, such as robotic surgical solutions and systems that will use big data to completely transform the way vets work, and according to Greg, while nobody should expect to see robots performing surgery on animals any time soon, change is coming and the veterinary profession must be ready.

He said: “I have been working on robot surgeons for five years and it is way outside five years for veterinary. For a medical robot surgeon it is very easy comparatively because the surgery to be done is identical. The patients are nearly identical and it has always got somebody – a best in the world person – looking over its shoulder.

“For a veterinary surgical robot to do the same thing, it has to be able to do that for a massively different range of patients. The surgery is always slightly different and the system is no where near good enough yet, but it will come – just not within a five-year time frame.

“As for what your consult looks like; we talked about the various sources of data either making it easier for clients to give us data or making it easier for us to take data remotely from place to place, or making it easier for us to gather data without the client even noticing we are gathering data from around where the pet lives.

“All of that comes together in a perfect future consult where you are offered options – there is all sorts of diagnostic support and differential diagnosis offered to you that you can then select from, and you don’t have to work out doses of things if you say you want a particular drug; the dose is automatic.

“Hopefully you can turn the three or four minutes of hardcore thinking time in a consult into a three or four-minute consult where it is all hardcore thinking time and there is none of that wastage.

“Whether people can handle that without burnout, I don’t know, so hopefully future consults come along with better care for workers built in, too.”

“There’s a great opportunity for somebody here to look after the nation’s pets really well. I think the threat is that it is not going to be the vet industry as it stands at the moment.”

Greg Dickens

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