It was about 1990 in Kansas City, Mo. We were judging entries for an excellence in veterinary practice management competition. Three of the six-member team of judges were veterinarians: Ross Clark, DVM, widely considered the first veterinary practice management expert, co-founder of a veterinary practice in Tulsa, Okla., and who had visited hundreds of veterinary practices across the U.S.; Dennis Cloud, DVM, a practice owner in the St. Louis area; and myself, a “young gun” veterinarian whose motto was “Ready. Fire. Aim!”
The focus of the competition was to ferret out the practices that were the most innovative, forward-thinking, and financially successful. After the first day of judging, the conversation at dinner turned to what was on its way out in veterinary medicine on the practice management side. We came up with a short list, including the demise of charge accounts and paper medical records, along with the shift from a profession made up mostly of men, to one made up mostly of women.
Then we turned our attention to the medical side of practice. For years, I had teased Dr. Ross that he was the lead veterinarian on the ark. He had an almost encyclopedic knowledge of all aspects of veterinary medicine, and led this discussion looking at what we thought was on its way in. We talked about digital radiographs, dentistry beyond ultrasonic cleaning, nutrition, and diagnostics-like endoscopy and ultrasound.
That was yesterday’s crystal ball, though. Now, our profession is entering an era rich with products and procedures like wearables, remote sensors, DNA testing, testing for cancer genes, and more.
This column’s co-author, Fred Metzger, DVM, MRCVS, DABVP, has a few predictions. Over the next three years, Dr. Metzger anticipates the rise of diagnostic acute phase proteins (APPs), which include c-reactive proteins (CRP) in dogs and serum amyloid A (SAA) in cats. These tests look for inflammation, which our colleagues in Japan and Scandinavia have already used for years. Dr. Metzger thinks it is time for the U.S. to embrace this useful parameter.
The future of diagnostics
In the next three to five years, Dr. Metzger predicts we will see more use of diagnostic bloodwork and urine testing prior to the office visit, so results are available and can guide the physical exam and treatment plan, as is common in human medical practice already.
Advantages of this new concept would include more accurate results and increased practice efficiency. More accurate results occur because venipuncture can be performed by trained technicians in a Fear Free environment.
Further, reference laboratory artifacts, which are a result of delay in processing, are now eliminated because samples are processed in a timelier manner. Practice efficiency is increased because blood and urine samples have already been collected, processed, and reported prior to the appointment, saving staff time and allowing for improved appointment scheduling.
Looking even further into the future, five or more years down the road, Metzger thinks the information gleaned from the MARS Petcare Biobank will change veterinary diagnostics significantly. This 10-year endeavor will enroll up to 20,000 pets (10,000 dogs and 10,000 cats) in the largest, most comprehensive study ever performed in veterinary medicine. The goal is to find ways to prevent and predict diseases earlier through DNA profiling, plus blood and other diagnostic testing, and help develop new diagnostics and treatments. New diagnostic tests and patterns of disease recognition should emerge through artificial intelligence and new algorithm development.
What veterinary and pet industry professionals expect
In oncology: David Haworth, DVM, PhD, expects an increasing understanding that “cancer is a disease of mutations.” Dr. Haworth says, in human oncology, it is now standard of care to determine which mutations are driving a particular patient’s tumor growth.
As genetic testing becomes more available, veterinarians will be able to understand exactly which molecular pathways are broken and find new options to attack that tumor. They will be able to diagnose poorly differentiated tumors, provide prognostic clues to predict tumor behavior, and, most importantly, can open a whole new world of therapeutic possibilities.
On genetics: Ernie Ward, DVM, CVFT, is also looking at genetics in the veterinary medicine crystal ball. “Pets can’t talk, but their DNA can,” Dr. Ward says, adding, “pet genetic testing is experiencing a renaissance in sequencing capabilities and disease catalogs while becoming increasingly affordable for every pet parent.”
Over the past decade, pet DNA tests “have progressed from ‘What’s your pet’s breed?’ to ‘What are the diseases your pet is at risk for developing?’” Ward says. Combining genetic testing, oral microbiome, and basic lab tests utilizing artificial intelligence (AI), such tests will aid veterinarians in identifying disease risks before symptoms develop. “Genomics and genetics are the roadmaps for the coming era of precision medicine,” Ward says.
On radiology: Tony Johnson, DVM, DACVECC, emergency clinician at Noah’s Animal Hospitals, says, “Medicine marches on and veterinary medicine is no different.”
While the vet hospitals of yore may have been lucky to have an X-ray machine, Dr. Johnson says newer clinics boast of digital radiology (which greatly reduces both image processing time and exposure of patients and staff to radiation) as well as CT scanners, ultrasound, and a host of other imaging technologies.
“As an ER vet myself, ultrasound has changed the way I practice,” he adds. “Beyond just the machine itself, a relatively new way of using ultrasound has made treatment of trauma patients faster, safer, and more predictable. It can be performed quickly, often within minutes of the patient arriving at the hospital.”
On data gathering and wearable tech: Bruce Truman, MBA, believes we will see increased ability to effectively monitor a pet’s health data in real time from home and share with care providers.
John Honchariw, a Bay Area-based expert in pet-related technology, agrees, predicting further development of wearable and in-home sensors, which are already on the market and capable of detecting gross/large deviations.
The next generation of smart products will use software that can automatically interact with the animal, and a sensing modality that allows for orders-of-magnitude finer, larger, and more convenient data.
Instead of a rechargeable, loose collar, searching passively for large changes in movements with a dog, a wall-powered device can observe the pet in an environment in which they are comfortable.
Dr. Honchariw points out that, in veterinary settings, the current process for monitoring key animal health vitals is manual (e.g. stethoscope for heart rate, paper for tracking, etc.). These methods are costly. They also require repeatedly touching the animal, often resulting in heightened animal stress and aggressive behavior. Typically, 15 percent of a veterinarian’s practice time is manually taking key vitals. Data from non-invasive pet health monitoring solutions can be integrated into a practice’s PiMS.
Another important use of wearables and non-invasive monitors is in the area of pain management. “Fear Free is dedicated to reducing fear, which we know is linked to pain,” says Ralph C. Harvey, DVM, MS, Diplomate ACVAA, UTCVM. “Wearables can provide real-time monitoring for qualitative and quantitative acute and chronic pain through technologies like skin-based sensors that transmit an individual pain biosignal for software visualization.” This, he adds, could enable veterinarians to visualize real-time pain responses during exams, surgeries, treatments, and to track pain over time.
On access to care: Truman predicts we’ll see the growth of virtual care as a first line of defense, routing cases to the appropriate level of care. Combined with tech-forward solutions and the provision of care in the home by veterinary nurses/technicians, we can de-stress the healthcare system and open exam rooms for high need medical cases.
Are we right? Wrong? Maybe one day some younger veterinarian will look back and shake her head at how misguided our predictions were, or maybe we’ll be looked back on as the Drs. Nostradamus of 2050. Whatever direction it ends up taking, change is coming to the profession we love—let’s make it a good one!
Marty Becker, DVM, writes every other month for Veterinary Practice News. He is a Sandpoint, Idaho, practitioner and founder of the Fear Free initiative. For more information about Fear Free or to register for certification, go to fearfreepets.com. Columnists’ opinions do not necessarily reflect those of Veterinary Practice News.