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11:44 AM   April 24, 2014
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Telemedicine Is Better, Faster, Now

By Don Jergler
For Veterinary Practice News

Posted: Jan. 24, 2013, 6:45 p.m. EST

Better, faster, now.

Those words best describe the goals of the rapidly growing telemedicine industry, a frontier that technology is opening up to any area of medicine that enables practitioners to use an image to help them treat their patients.

Advances in technology and the ability of people and businesses to handle increasingly more bandwidth have enabled service providers to expand their offerings, giving veterinarians in many cases almost real-time consultation opportunities with specialists.

It’s that increasing broadband speed that is expanding telemedicine beyond its core service of teleradiology and into areas like tele-endoscopy, tele-ultrasound, tele-arthroscopy and teledentistry, said Jim Waldsmith, DVM, president of Vetel Diagnostics in San Luis Obispo, Calif.

“That is opening up the role of a consultant to anything that makes an image,” said Dr. Waldsmith, who also serves as a staff veterinarian at The Equine Center in San Luis Obispo.

A Growing Market
According to BCC Research, the telehealth market globally is expected to double to more than $27 billion by 2016, and while a large portion of that will be driven by home health and disease management monitoring, experts see the veterinary telemedicine market growing in step with the larger segment.

Besides real-time or near real-time capabilities, many telemedicine business models tout quality and services.

Others tout affordability. VetDentalRad.com, for example, charges only $45 for a standard case review. All of the consultants with VetDentalRad.com are practicing board-certified veterinary dentists engaged in private clinical practice, according to the firm’s website, which also promotes a 24-hour turnaround option for a few dollars more for near real-time image readings.

“We offer you the ability to receive a STAT reading within a few minutes, while the patient is under anesthesia!” the company proclaims on its site. “This will greatly increase the clinicians’ ability to treat the patient with one anesthetic event, as well as increase the level of confidence that the treatment decisions are correct.”

Telemedicine is a hot topic among companies looking to capitalize on market growth, and among the general public. Google the term “veterinary telemedicine” and you get more than 3,000 results. Thanks to such growing interest, Waldsmith says the field has grown tremendously in recent years. But he sees much more growth to come.

Waldsmith believes the industry is on the uphill side of convincing the majority of veterinarians that there is value in partnering with a telemedicine specialist and buying more advanced equipment for their practices. And he believes the industry is nearing the peak of that task, and that as such services and products become more convenient, easy to use and affordable, a flood of new veterinarian customers will hit the market.

Waldsmith outlined the task at hand: Currently there are many vets who may have financial reservations about buying a premium ultrasound unit versus a more basic and affordable one. The general practitioner quite often doesn’t have the expertise to use such equipment to full capacity, Waldsmith added.

Digital x-ray
A core service of telemedicine is teleradiology.
To address this issue Vetel is among a growing number of telemedicine firms that offer value-added services along with the equipment they sell to entice reluctant customers.

Vetel set ups equipment to provide a direct interface with various specialists, and also offers a list of experts from whom to choose—and it offers to facilitate introductions between telemedicine service providers and veterinarians.

Vetel has partnered with specialists who will provide a complimentary consultation or two.

Vetel sells about 200 systems per year that fit into the “real-time” category, which is where Waldsmith sees a great deal of growth occurring. How much growth will a firm like Vetel will see over the next year or two? Waldsmith noted that the deciding factor will be convincing more veterinarians that telemedicine is good for their practices and their clients.

“That’s the complete unknown,” he said. “It’s evident that everything is going to be connected to the Internet, and we certainly have the infrastructure for all of that. I think the limiting factor is the comfort level of the vet practitioner in using that equipment for telemedicine.”

Embracing the Consult
Brian A. Poteet, DVM, owner VitalRads LLC of Houston, is a board-certified radiologist in the teleradiology business since 1994. He sees more vets embracing the need for consulting with a specialist to better serve their clients’ needs.

“More and more (vet) clients are realizing that they need the help of a radiologist,” Dr. Poteet said.

Many vets can read a radiograph and spot, for example, a fracture, Poteet said, “but sometimes they don’t see subtle anomalies on the film.”

It’s why he believes clinics increasingly are choosing to farm out images they shoot for consults.

“Over time they can see that they are missing things and they are not seeing the entire picture,” said  Poteet, whose firm offers consults on all  modalities in use in veterinary teleradiology, including digital radiography, ultrasound, CT, MRI and nuclear medicine procedures.

Tele-ultrasound is one specialty Poteet believes will see near-term growth. Several new products are set to roll out the first quarter of the year, he said.

“I think that’s going to be a big thing too,” he said, adding that with broadband speeds continually increasing, “It enables a whole other ball game when it comes to ultrasound. It’s getting to the point where they can almost do it live.”

Such a roll-out of tele-ultrasound services could conceivably change the landscape of the market in terms of professional training. Typically vets go to “weekend crash courses” to learn how to better perform and interpret ultrasounds, then they get back to their clinics, get busy and forget what they’ve learned, Poteet said.

But with live tele-ultrasound, that learning can be reinforced. Vets can get a live lesson with an instructor, and even conduct an exam together, he said.
“Over time it will help these veterinarians,” he added. “They will feel more confident they aren’t missing things.”

Speed and Quality
As important as the speed at which images or information can be transmitted is the quality of that information, according to Jeff Brokalis, vice president of Asteris, a Colorado-based interactive services and consulting agency that delivers storage, networking, software and Web solutions to veterinary practitioners.

Asteris works to provide image storage that meets what Brokalis calls a “lossless standard,” ensuring that pixel for pixel, the image that is sent from the clinician to the specialist and back is the same as what was transmitted.

“When a doctor sits down and a radiologist sits down they need to be assured they are looking at the same image,” Brokalis said.

The technical aspect to that is to ensure that DICOM standards—the acronym for Digital Imaging and Communications in Medicine, a standard for transmitting and storing medical imaging—are maintained. 

In short Brokalis’ firm makes it possible to get images from point A to point B quickly without loss of quality using a patented technology to package a DICOM image.

“We’re in the business of making everybody talk to each other,” said Brokalis, who enjoys offering a lengthy technical treatise on the behind-the-scenes technology that must be worked out as the field of telemedicine continues to grow.

Technology Drives Growth
Brokalis believes that pace will increase with the help of advancing technology.

“Telemedicine has been our fastest growing area,” he said. “I would say our company has doubled in size, and the doubling has happened because of telemedicine.”

According to a report on mobile health by PricewaterhouseCoopers in October,  all areas of medicine, including telemedicine, will see rapid growth thanks to continued advances in technology.

“The growing pervasiveness of technology is enabling the emergence of a new, more patient-centric healthcare value chain,” the report states. “As a result, conventional business models, which typically place consumers at the periphery, may soon no longer apply. To lead, all stakeholders—physicians, hospitals, health insurers, pharmaceuticals, medical device companies and government—will likely shift their practices toward patient/consumer models that will focus on clinical outcomes, value and patient satisfaction.”

Anne Bahr, DVM, of telemedicine consulting firm PetRays of Spring, Texas, said as more vets add imaging equipment the field will increase in size and in the scope of capabilities offered.

“The growth of telemedicine is expected to continue to increase in 2013 and beyond as more and more clinics add the necessary equipment,” Dr. Bahr said. “As more and more clinics make the switch to digital equipment, the use of teleradiology increases proportionally.

“The types of services that can be performed with telemedicine are continually rising as new technologies become available. However, radiology consults will likely remain the most utilized service. At PetRays, cardiology service expansion is planned for 2013.”

The biggest technical challenge, she said, is setting up clinics that have older X-ray equipment.

The company, like many service-providers in the field, is more than happy to help.

“At PetRays, we have a wide range of proprietary software that allows virtually every clinic to benefit from our services,” she said. 

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