Today's Veterinary Business

FEB 2019

Today’s Veterinary Business provides information and resources designed to help veterinarians and office management improve the financial performance of their practices, allowing them to increase the level of patient care and client service.

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17 February/March 2019 • TODAYSVETERINARYBUSINESS.COM prohibitive. Without understanding the distinction between telehealth and telemedicine, one could be for- given for thinking that AVMA was against telehealth more broadly, but it was not. Negative Influences This leads into the second prob- lem: the spirit versus the letter of the document. When reading the report, one perceives a decidedly negative tone toward telemedicine, or at the very least, that telemed- icine should be conducted only within the confines of a previously established VCPR. This is a con- servative stance, one the AVMA is well known for taking. Again, this is not a criticism of the AVMA; the organization is simply voicing its members' concerns. I'll turn to those concerns shortly. As one reads the document, the message becomes clear: The membership is not in favor of establishing the VCPR through electronic means. A whole realm of opportunities is open to practi- tioners, but because of the nega- tive attitude toward telemedicine, many veterinarians decided to distance themselves from the tools. The Veterinary Innovation Council provided numerous presen- tations to local VMAs, state boards, national meetings and smaller asso- ciations. At each meeting, someone inevitably would approach me or another presenter and attempt to explain that AVMA was against tele- health tools. This was not the case, but it was a general perception carried among members. As a result of the nomenclature and the spirit of the report, many practitioners took on the position that "telemedicine is bad medicine," as I heard while visiting a veterinar- ian to talk about telehealth tools. Front-Line Receptionists All this has led to a slower than typ- ical adoption rate for new forms of telehealth technologies that enable practitioners to expand their capac- ity for care to the external commu- nity not able to access that care. Take, for example, the phone calls that receptionists field every day that purportedly concern a pet's health situation but are really a form of this question: "Do I need to come in?" Receptionists are often forced into a situation where they triage calls. This is not a posi- tion any receptionist should be in. As a consequence, pet owners are met with a receptionist's best guess or "the doctor will have to see the pet to tell you," or they make a quick trip to Dr. Google. Telemed- icine triage tools can help with all this, but the profession's reluctance to adopt these technologies has, at best, prohibited access to care. Two of the main issues that inhibit client access to care are cost and convenience. It's prohibitive to pay for an appointment that wasn't required and to take the time out of one's day for a condition that might be normal. Plenty of remote diagnostic tools entering the mar- ket can overcome these barriers. I would argue that veterinarians' delay in exploring new telehealth tools as a complement to their cur- rent practice has actually created space for more technology compa- nies, thus hastening the displace- ment of veterinarians even further. An Open-Minded AAVSB Despite the report's reticence, other groups plowed ahead. Some of these groups came from within AVMA and others from elsewhere, like AAVSB under the leadership of executive director Jim Penrod. He put together a group to review AAVSB's current Model Act of Prac- tice to see if room was available to establish a VCPR without the necessity of a hands-on exam and instead simply require veterinari- ans to exercise their best judgment as to whether they had sufficient information to diagnose, irrespec- tive of the medium used for gather- ing the information. The result is a beautifully written document that allows for just such a thing. At the same time, the Veterinary Innovation Council was running telehealth pilots, providing over a dozen talks across the continent, establishing online resources, engaging stakeholders like AVMA and AAHA in productive dialogue, and working with veterinary start- ups and interested practitioners. All this was an attempt to build a groundswell of interest that hope- fully would influence people to understand the distinction between telehealth and telemedicine and start trying out new technologies on their own. Two groups that fit squarely into separate camps have emerged: • Early adopters like Drs. Aaron Smiley, Lori Teller, Jess Trimble and Ryan Farmer, among others, who have taken up the mantle of in- corporating telehealth tools into their practices to better accommodate patients' needs. These users, whether aware of it or not, are leading the charge toward telehealth and serving as models for the curious masses. • Late adopters, who are not passively waiting as the early adopters figure things out. Rather, this group is trying to squash early adopters' efforts by pronouncing, unequivo- cally, statements like "Tele- medicine is bad medicine." An interesting field in neuro- science walks through why people react strongly against that which disconfirms pre-existent beliefs, but I'll save it for another time. Harmful Groupthink Here is one of the most frustrating things from an outsider's perspec- tive: The veterinary profession is one of the most interconnected, meaningful and rewarding careers that one can take on. And yet, so many people within the profession speak too loudly and proclaim too confidently about a particular issue, all the while relying on little more than the force of habit that underpins their assumptions. The groupthink that is so pervasive within the profession is simultaneously the source of its greatest strength — the ability to disseminate and rely on others for best medical practices — and its greatest weakness. Relying on others for our own thinking perpet- uates negative practices and delays adoption of new technologies that, once properly understood, are more than a matter of supplemen- tal care. The technologies are going to be seen as a requirement of care. Telemedicine will become the standard of care. When an animal is hurting and veterinarians deny care because they can't lay hands on the animal, but they do have video conferenc- ing, FaceTime, text messages and other tools, then what becomes clearer is that such actions are a form of negligence. Until such time as telehealth tools are seen as the standard of care, I can only hope that veteri- narians will continue to push the envelope and be scientists with respect to treatment options. Never sacrifice or compromise the health of the animal, but con- stantly look for opportunities for experimentation so that the best care possible is provided to as many animals as possible. Until then, the Veterinary Innovation Council will continue to do its work and con- tinue to help early adopters and enable best practices across a range of issues affecting the profession. If you are a forward-thinking practitioner, please reach out. We need more people like you. Innovation Station columnist Dr. Aaron Massecar is executive director of the Veterinary Innovation Council. • "The Real-Life Rewards of Virtual Care: How to Turn Your Hospital Into a Digitally Connected Practice With Telehealth" is available at http://bit.ly/2CNSwcM. • The American Veterinary Medical Association's 2017 Final Report on Telemedicine is available at http://bit.ly/2UgHx2U. LEARN MORE

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