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Technology and the 21st century exotic animal veterinarian: positives and negatives.

IPads, iPods, iPhones, digital imaging, video chatting, and more.... So much technology, so little time! How do we keep up? More importantly, how did we ever survive without all of this stuff?. Whether in our personal lives or our professional lives, we are literally bombarded with technology. It's on TV, on the radio, in our offices, in our homes, with our family members, physically on our bodies. Is it all necessary? Does it really help us? As a recent article by Ramon Ray on smallbiztechnology.com recently asked, "Is your business productivity low because of old technology? Are you wasting money because of old technology?" The purpose of this round table discussion is to ask just this: how has all this new technology affected vets both personally and professionally in the 21st century?

To help answer this question, I have invited 7 participants from different areas of veterinary medicine and from different geographic regions. The participants are Douglas W. Folland, Dipl ABVP (Avian), Parrish Creek Veterinary Clinic, Centerville, UT, USA; Susan Horton, DVM, Chicago Exotics Animal Hospital, Skokie, IL, USA; Jennifer Langan, DVM, Dipl ACZM, Brookfield, Zoo, Brookfield, IL, USA; Maureen Murray, DVM, Dipl ABVP (Avian), Tufts Cummings School of Veterinary Medicine, North Grafton, MA, USA; Gary Riggs, DVM, Dipl ABVP (Avian), North Coast Bird & Exotic Specialties, Norton, OH, USA; Gary Schwartz, DVM, Wheaton Animal Hospital, Kensington, MD, USA; and Marcy Souza, DVM, MPH, Dipl ABVP (Avian), DACVPM, University of Tennessee College of Veterinary Medicine, Knoxville, TN, USA. I hope that in hearing their responses, we will all think about how we might better our own personal and professional lives with select technology. If nothing else, we might have a better idea, from all the new technology available, what's really useful and what's not.

Laurie Hess, DVM, Dipl ABVP (Avian Practice) Associate Editor

Question: What one single piece of technology has had the most impact on your practice of veterinary medicine?

Dr Folland:

I think the computer has had the biggest impact on my practice over the past 28 years. It has affected practice management, collection of information, equipment, and just about everything we do and use in the practice. In my senior year of vet school, I was amazed I could type my senior paper on a word processor and actually come back later and change things. Can you even buy a typewriter now?

Dr Horton:

It is my website. The website is often the first thing that the public sees. When my brother and I created our website years ago, it was one of those things that I had heard you should do. It has paid off well over all those years! Now, I use it for clients to preprint check-ins, collect information, contact me, and more. I really enjoy working on it, too. We have all our handouts there ready for people to use. We describe diseases for clients to gain a better understanding of their pet's problem. We link to sites with good information.

Dr Langan:

The technology that has had the most impact on our practice is digital imaging, specifically digital radiography used in conjunction with computed tomography (CT). Over the past several years we have upgraded our imaging capabilities to include these more sensitive and efficient diagnostic modalities. The information they are able to provide has greatly enhanced our capabilities to detect and diagnose medical conditions in zoological species. Our patients are generally examined under anesthesia, and the speed of digital imaging has greatly reduced the procedure and anesthesia time, improving patient safety.

Dr Murray:

Digital radiology has been beneficial in many ways, including increased ability to email, share, and publish radiographs. I have found the increased ease of recalling and comparing prior radiographs especially useful in evaluating fracture healing.

Dr Riggs:

If we're talking about diagnostic tools, I'd have to say radiography is my go to if I want the most information in the shortest period of time.

Dr Schwartz:

Multiple parameter monitoring devices during anesthesia have had the biggest impact. Now we can safely monitor anesthesia in patients from the size of a small dog to a large mammal during prolonged procedures. It's quite a relief knowing when an animal is starting to have anesthetic related problems before it's too late.

Dr Souza:

I am in an academic setting, so we have all of the toys at the university, but we don't have everything at the zoo. Digital radiography has probably had the most impact because of the rapid turn-around (and re-take, if needed) of films and ability to magnify areas of interest.

Question." What one single piece of technology has had the most impact on your personal life?

Dr Folland:

I think it is computers, again, especially if you include all devices that utilize an internal computer such as automobiles, cell phones, household appliances, etc. The promise of computers at the onset was that they would simplify our lives. In reality, they have made life much more complex. They have allowed us to do more in a shorter period of time, but the pace of life has increased and certainly isn't simpler.

Dr Horton:

It is my iPhone. I use it constantly to check and answer emails, social pages and groups, contact colleagues and friends. I can get quick answers and serve my clients in a more efficient manner. It is with me constantly. I am answering work questions quickly or consulting with the emergency room without much interruption in my regular activities. It is amazing how much a single device can become so important in your everyday life.

Dr Langan:

Smart phone--the ability to send and receive images (photos, radiographs etc), email and real time updates (instant messaging) about patients and communication from colleagues or family has provided much more flexibility to be able to blend and balance both work and personal responsibilities.

Dr Murray:

I've purposely remained a relatively low-tech person in my personal life, but my recent acquisition of an iPad has allowed me to see the allure of the "app."

Dr Riggs:

Both personally and professionally I'd have to say the networking and informational opportunities of the Internet (and all of its various spinoffs) have had the most impact. For those of us who were around before the computer era, it is hard to describe our information and communication limitations prior to its widespread usage.

Dr Schwartz:

The home computer has definitely had the greatest impact on my personal life.

Dr Souza:

Honestly? My iPhone! It allows me to keep up with emails while traveling, look up stuff on the Internet, take pictures (because I never remember to bring a camera), and have my calendar synced, so I know where to go next. I would rather lose my wallet than my iPhone!

Question: What one single piece of technology do you wish you could have in your practice that you don't?

Dr Folland:

I have had my eye on digital radiology for a few years now. I keep hoping the price will come down to make it a financially viable option to add to my solo practice.

Dr Horton:

I would love to have a tablet for room to room use. Wireless technology is great! When you can bring the technology from room to room to take notes, pictures or movies for the medical record, create follow-up documents, show radiographs to the client, I think that is great! Not only can it house all of your reference manuals, but also it can connect you to important information or network sites and be an access port for all of your radiography. I love it!

Dr Langan:

Cost aside, I wish we had open magnetic resonance imaging (MRI). Despite the excellent capabilities of digital radiology and CT, MRI provides higher detail of soft tissues and is better for imaging central nervous system, joints, musculature, urogenital and gastrointestinal systems. It avoids ionizing radiation and provides advanced imaging capabilities for larger patients that do not fit into a closed MRI or are above the usual weight restriction.

Dr Murray:

Our clinic does not yet have electronic medical records, which I think would both improve our record keeping and decrease our impact on the environment.

Dr Riggs:

I wish we could have time travel.

Dr Schwartz:

I wish I had a survey digital radiography machine. We already have a dental digital radiography machine, but not for taking survey radiographs.

Dr Souza:

I wish I had a very small flexible endoscope. We had one previously, but it now has issues.

Question: What one single piece of technology that has yet to be developed for veterinary medicine do you wish existed to help you run your practice better?

Dr Folland:

I would love one of those hand held devices used by Dr McCoy on Star Trek that diagnoses and treats all at the same time by just waving it over the patient. In birds and reptiles, I would love to have blood tests that could more accurately diagnose many of the common diseases we see. The serum chemistry panels available to us now shed so little light on liver, kidney, pancreatic and other internal diseases. Wouldn't a chemistry panel be nice, where the 20 values measured actually help with diagnosis? One thing we have to remember is that technology can never take the place of clinical skills such as decision making, clinical judgment, good history taking, communication, and observation. Sometimes we turn too quickly to technology when these skills will best solve the patient's and client's problems.

Dr Horton:

Integrative software that connects our clients with their records, diagnoses, descriptions of illness, etc, would definitely help my practice to improve service to clients. We need a program that starts easily from your in-house software for day to day business and then easily integrates with your website and social networks.

Dr Langan:

Currently, multiple anesthetic procedures are required to accomplish all or some combination of advanced imaging in our zoological species. If technology could combine the imaging capabilities of digital radiology, CT, and MRI into a single efficient piece of scanning equipment, more patients could benefit from these technologies. Risk associated with long anesthetic procedures and cost are the primary reasons we choose one imaging modality over another for specific patients.

Dr Murray:

As I practice wildlife medicine exclusively, something that would allow me to make better clinical judgments based on post-release survival data would be a single tracking device that is inexpensive, compact, noninvasive to place, and works equally well for multiple species across different taxonomic groups.

Dr Riggs:

For those fortunate enough to have access to the new digital endoscopy, CT, and MRI, the future seems like now. Certainly, I will always appreciate equipment scaled for our patients' size requirements and our clients' financial constraints.

Dr Schwartz:

I wish I had a computerized scanner that could evaluate total body system function for the species of animals on which I work. This scanner would tell me which system(s) in the body are malfunctioning, where in the body the problem(s) exist, and also give treatment options, along with risks.

Dr Souza:

I wish I had wireless monitoring devices for anesthesia. I think they are available for human medicine but are probably very expensive and probably not accurate for very small critters. All of the cords get very cumbersome when they are attached to a one-pound guinea pig.

Question." What single piece of technology did you/ your company invest in for your practice that didn't help your practice as you had expected?

Dr Folland:

I spent a fair amount on endoscopic surgical instruments (for use on birds and exotics) which, for the most part, are only making expensive paper weights.

Dr Horton:

I am currently unhappy with my digital radiograph system. Be sure to research all technology well before you purchase it. I lease, so I didn't have much say in the current choice. We are upgrading soon, hopefully, to a better detail oriented system! The current system had some features that we wanted, but it didn't deliver on the sharp detail promised on small patient radiographs. I should have called the company's references before saying it sounds good to me.

Dr Langan:

Several years ago, we purchased a TonoPen applanation tomometer which did provide us a much improved capability to measure intraocular pressure. However, it still generally required restraint or sedation in our zoo patients. Relatively soon after acquiring this new technology, the TonoVet became available which is much better tolerated by our exotic animal patients. Advantages of the TonoVet in our practice are its speed, decreased need for restraint (we don't need to hold the patient's eyelids open), and excellent patient tolerance.

Dr Murray:

At our teaching hospital, our equipment has value as teaching tools even if certain pieces are used less frequently than others. Having students see ultrasound or electroretinography performed on wildlife species shows them how their skills as veterinarians can be applied to a range of species and makes the investment in that equipment worthwhile.

Dr Riggs:

For the most part, we investigate potential investments thoroughly before purchasing them to know if they will fit our practice. We have had problems with monitoring devices living up to their promotion on small exotics.

Dr Schwartz:

I can't think of any important piece of technology that we regret getting, but there are several minor examples such as aural thermometers.

Dr Souza:

The one thing that really didn't help is the hands-free restraint device for rabbit and rodent dentals. This device always seemed to take a long time to get the animal set up. We also have many students that can aid in restraint and holding of animals for quick dental procedures.

Question." What factors do you consider when you think about adding new technology to your practice?

Dr Folland:

The factors I consider are: Will it help me practice better medicine and serve my clients? Will it support itself economically? Do I have the time and energy to learn how to use it? Will it enhance my practice experience (help avert boredom and burnout)?

Dr Horton:

I want something that will benefit as much of my practice as possible. It should make our work easier, be easily understood by my staff, and provide a valuable service to clients. I don't want to spend a lot of money, either. If I find a product that sounds attractive, I try to find as many people that I know using that product and discuss it with them before making the purchase. There are many online sites that discuss pros and cons of technology, too. Everyone should have some professional technologic people in their life, whether for repair or consultation. It is too hard to keep up with everything. Always seek advice from those who do this for a living. I love my tech guys. They have saved my day on more than one occasion!

Dr Langan:

One of the most important factors we consider is whether it will benefit our patients. If so, to what extent (ie, how many patients and how often would they benefit from this new technology?)? We also evaluate if all clinicians in our practice will be able to take advantage of the new technology (ie, does it require additional or specialized training?). We certainly also consider if it will improve hospital's work flow, and we evaluate the immediate and long term cost to benefit ratio.

Dr Murray:

Since I work at a nonprofit wildlife hospital, we first think about whether we can obtain funding to purchase the equipment. The process of obtaining funding aids critical evaluation of whether that equipment will enhance diagnostic, therapeutic, teaching, or research capabilities in the clinic.

Dr Riggs:

We mainly consider whether new technology will improve our level of patient care. Certainly, price plays a role, but we've found if the equipment can truly improve quality of care, and our staff is properly trained in its use and benefits, we are able to demonstrate the benefits and recoup costs with our clientele.

Dr Schwartz:

I ask, can I personally afford to purchase it? Will the purchase of this item potentially make my life easier, less stressful or more enjoyable, outweighing the possibility of a poor (subpar) financial return?

Dr Souza:

We consider what would be useful for our patient population and how much money the department is willing to give us that year. We already have lots of toys in our hospital and are limited by the department as to what we can spend money on each year.

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Title Annotation:Round Table Discussion
Publication:Journal of Avian Medicine and Surgery
Article Type:Discussion
Date:Dec 1, 2011
Words:2754
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