In addition to being economically feasible, consulting with specialists via telemedicine is smart medicine, those in the business say. Telemedicine keeps patients at the primary care office, retaining revenue, while providing real-time specialty care through a board-certified consultant.
Clients are assured of expert care and save time by not having to make an appointment elsewhere with a specialist. In the middle are the consulting companies, which report that they work hard to accommodate practitioners’ schedules.
“Many of the cases we see cannot be referred due to cost or the need for a short turnaround on results,” says Jennifer S. Fryer, DVM, executive director of Veterinary Answers LLC in Harrison, N.Y. “We work with specialists in anesthesia, small animal internal medicine, large animal medicine, dermatology and nine other specialties.
“The turnaround time is based on the veterinarian’s need, but typically it’s within a few hours,” Fryer continues. “When it comes to imaging, we collaborate with PetRays, which offers stellar radiology, cardiology and dentistry consultations.”
Services such as Veterinary Answers, Idexx Telemedicine Consultants and North Carolina State University’s Veterinary Telemedicine Group all report that their technology is easy to use when connecting general practitioners with board-certified veterinarians. In some cases, setting up an account in advance will save time when a patient is waiting.
Veterinary Answers LLC
Consultants working with Veterinary Answers provide undivided focus when working with a primary care veterinarian, Dr. Fryer says.
“The veterinarian must have 100 percent of your attention during the phone call,” Fryer says. “Some phone calls take 10 minutes, others may take much longer. We are there to discuss the case as much as is needed. If something regarding a case is outside the specialty, we’ll find the right person to consult on that aspect of the case. Sometimes that means we have two or three consultants weighing in on a single case.”
Although Veterinary Answers doesn’t interpret images, the service will review them during an evaluation. Veterinarians can send as much history on a patient as they want without fear of raising the fee.
“We encourage veterinarians to take digital videos of their neurologic exams or videos of a neurologic animal’s behavior,” Fryer says. “For dermatology and ophthalmology, we encourage veterinarians to send pictures of the lesions. And for every case, the veterinarian is encouraged to send case summaries and lab results by email or fax.
“Once we receive all the case information, we pass it on to the specialist on call for that particular specialty,” she adds. “The specialist discusses the case with the veterinarian and is available for follow up on consults, as needed. In fact, we have a number of internal medicine cases that have had long-term follow up of many months or even a year or more.”
Veterinary Answers plans to increase the number of standard-of-care consultations for clinics that want to improve a particular aspect of their practice.
“Our anesthesiologist, Courtney Baetge [DVM, Dipl. ACVA], can talk with a veterinarian about their current anesthesia and pain-relief protocols and offer ideas as to how to improve the quality of pain relief as well as make anesthesia a smoother and safer process for the staff and patient,” Fryer says. “Our oncologists can discuss setting up chemotherapy protocols. Our dermatologist can discuss how to approach specific types of dermatology cases or discuss the pros and cons of topicals available on the market. Our avian and exotics specialists can discuss protocols for managing these unusual patients.”
Veterinarians pick Idexx Telemedicine Consultants of Clackamas, Ore., for multiple reasons, says Don Schofield, the company’s director and general manager.
“Some veterinarians choose to send all their radiographs out as a standard of care,” Schofield notes. “They like to have the consultation information in the patient record. This allows the veterinarian to minimize risk and enhance confidence in their diagnosis. Additionally, the veterinarian is free to be more productive in other areas of the practice.”
The service has a continuing education aspect as well.
“In addition to the case evaluations, veterinarians can go to Idexx’s online Learning Center, which offers free webinars and tutorials,” Schofield says. “We plan to add radiation safety techniques and ultrasound techniques.”
Veterinary Telemedicine Group
In 2006, North Carolina State University joined the list of veterinary colleges offering telemedicine consultation. The digital service offers the expertise of board-certified radiologists in reviewing images provided by primary care practices.
“We see anywhere from five to 10 cases a day,” says James Brown Jr., DVM, Dipl. ACVR, a consultant with the Raleigh, N.C.-based Veterinary Telemedicine Group. “Most reports are generated by the end of the day while others are reviewed before 8 a.m. the following day. We also offer stat services.”
The consulting service is often used when a primary care veterinarian wants to be certain of a diagnosis before proceeding with surgery, Dr. Brown says.
“A recent case was of a dog presenting with acute abdominal pain,” he says. “The veterinarian was uncomfortable with the way the intestine looked on the radiograph and wanted expert advice before proceeding with treatment. The images showed that the dog had eaten nuts and had an obstruction from all of the foreign material. It underwent surgery following the consult.”
Pet owners who say “I can’t do that” when a referral is recommended often will approve a consult, Brown points out.
“Consultation gives veterinarians and owners another option,” he says. “Many of the veterinarians we read images for comment on how much they learn from the information we provide in our reports. Our reports are not limited to just the imaging abnormalities. Oftentimes we discuss disease processes and how they lead to the changes seen in the images. So another advantage to these consults is the big educational benefit.”
When personal interaction isn’t necessary, there’s Consultant, a veterinary diagnostic support system created in 1985 by Maurice E. White, DVM, a professor of medicine at the Cornell University College of Veterinary Medicine.
The online database contains about 7,000 diagnoses causes, about 500 signs and symptoms, more than 18,000 literature references and more than 3,000 Web links.
The free database covers the domestic species including dogs, cats, cattle, horses, sheep, goats, swine and birds. The service allows veterinarians to conduct their own research using a patient’s symptoms or potential diagnosis.
“Consultant was first used at Cornell and then leased as a free-standing database to several schools around the world in the days before the Internet,” Dr. White says. “It went on the Web in 1997 and since then we have averaged about 300,000 visitors a year, producing about 1 million page views a year. We have no way of knowing what proportion of these millions of visits and page views came from veterinarians.”
White says he receives emails from around the world, some of which offer thanks or database suggestions.
“The best positive feedback in this day and age is the fact that Consultant is No. 1 in Google and other search engines for the term ‘veterinary diagnosis,’” White says.
Veterinary Answers: www.veterinaryanswers.com
Idexx Telemedicine Consultants: www.idexx.com/animalhealth/telemedicine
Veterinary Telemedicine Group: www.telemedvet.org