Computers in Your Practice - fancy cash registers or valuable information and diagnostic tools - the choice is yours.
Paul D. Pion, DVM, DipACVIM (Cardiology)
Note: During the presentation I will focus upon specific applications, resources, and products (current and future).
In this paper I present a historical perspective of where we are, where we are going, and what we should hope to accomplish with computers in our practices.
Confessions of an early adopter who survived the dot.com craze.
I use computers a lot. But I am NOT a geek. HONEST!
The past few years have been crazy. It was a dot.com craze. My best guestimate is that over $100 million was wasted by more than 20 failed startup veterinary dot.coms. And if you include failed pet retailers who hoped to "partner with" the veterinary profession, the number rises to the staggering figure of nearly a half billion dollars!
In the wake of the dot.com craze, it is my hope is to communicate the wonderfully varied ways that computers and technology can help in your practice. Whether you are an early or a late adopter of new ideas and technologies, the important lessons to remember are:
Never let technology attempt to solve problems that don't exist.
Never spend money on information technologies that are NOT widely used for playing games, music or movies.
I don't claim to be able to predict the future, but I hope that a look back at how we got where we are today will help us see the future and choose wisely.
In the beginning.....
Not too long before I was born, it was predicted by the heads of IBM that there would perhaps be a need for a dozen computers in the world.
When I was about seven, my father returned from a business trip to Japan with the first electronic calculator I ever saw. It weighed almost a pound, could add, multiply, divide, and subtract. It was the first liquid crystal diode (LCD) screen I had ever seen. We had fun writing words on the screen using upside-down-numbers. Did you now that 01134 upside down spells "hEll0" It cost $400.
In high school (1971-1975), I had access to one of the (I'm guessing) tens of thousands of computers in the world at that time. So much for IBM's predictions!
The computer in my high school filled the greater part of a room and was encased in an air-conditioned container. I don't know how much it cost, likely tens of thousands of dollars. I "talked" to it and it talked back to me via a teletype. Mostly we programmed silly games on the computer. I stored my programs and data on teletype tape that I kept from unraveling with a rubber band.
During college (1975-79) I interacted with computers via punch cards. More silly games were the primary goal.
In veterinary school (1979-83) I gained access to a microcomputer, an Apple II. I generated (well, I mostly borrowed code published for use on another type of computer) a program that analyzed pharmacokinetic data I was collecting from cats. I hoped that understanding how to dose verapamil in cats would lead me to a cure for feline hypertrophic cardiomyopathy. I missed - I ended up finding a cure for dilated cardiomyopathy (taurine) a few years later - oops!
During my internship (1983) I acquired my first personal computer. It cost about $4,000. I discovered the joy of word processing, balancing my checkbook, electronic calendars, spreadsheets for generating dose regimens for emergency drugs, and a plethora of computer games. The following year I went online with Compuserve.
During my cardiology residency (1985-1987) I discovered the joys of databases for storing information about cases, research, and literature citations. I bought my first hard drive in 1985. It could store 10 Megabytes of data. Who could ever need more?
The following year I bought my first laptop. It weighed almost 16 pounds - I was mobile!!! It had a 10 Megabyte hard drive. Who would ever need more?
Once mobile, there was no stopping me! I could work anywhere generating slides to lecture, papers to publish, appointments to keep, phone numbers to dial, and faxes and email to be sent and received via my speedy 1200 baud modem!
Around the same time I succeeded in convincing a few close friends to join me on the online service called Prodigy. We exchanged email almost daily. We could only email others on Prodigy. It was a closed system that could not talk to anyone not using Prodigy.
In 1986 I bought my first Personal Digital Assistant (PDA). It was a Casio watch that allowed me to store some phone numbers, reminded me of appointments, and more. There was even a model that connected to a keyboard. Dick Tracy, here I come! Unfortunately I kept losing the information because it wasn't as water resistant as I had hoped.
The first truly useful PDA I owned was a Sharp Wizard. No longer did I need to wait 10 minutes for my computer to boot to find the phone number for a client or the local pizzeria! There was even a cable to synchronize the data with my computer. Some of my fears of lost data disappeared because I could back up my Wizard to my laptop and my laptop to floppy disks or tapes.
The late 80's also brought us the first electronic information management systems for veterinarians. Veterinary programs like Provides, the Quarterly Index on disk, and information and diagnostic assistance programs with names like Consultant, the Associate, Rx, and Hemo began to appear. Soon after VetSream was born in the United Kingdom. We began to see the promise of electronic books and computer assisted diagnosis. The promise is still in the making.
In the late 80's and early 90's I began exploring the joys and headaches of electronic medical records. At first I built my own practice database, then I tried a few "off the shelf" that were built for veterinary practice. Being focused on cardiology alone, my needs were pretty limited so I focused primarily on the reports generated and collating diagnoses made.
My clients and referring colleagues loved getting colorful reports with pictures of what was going on inside the hearts of my patients. That seemed to impress them more than whether the diagnosis was correct or the patient lived or died. Hmmmm....
Around this time (1990), email began to move from a toy I used to stay connected to my closest friends to a tool that enabled me to exchange information about the management of cases with clients and colleagues. Email really became useful when the walls came down and all email systems were able to talk to each other.
I thought I was wired. But then (1990) came Veterinary Information Network (VIN) on America Online (founded by Duncan Ferguson and myself), NOAH from the AVMA (1993) on Compuserve, and a plethora of listserves. My life would never be the same again. I was wired - or is it chained - to the world.
In 1991, VIN offered little in the way of information resources other than access to other colleagues on message boards and online conference rooms. We shared a few documents via electronic libraries.
In late 1991 VIN began offering continuing education courses online. Now in 2001, most states are finally coming around to accepting online CE as valid for credit and other organizations are beginning to offer online courses.
It was also in 1991 that many of my colleagues began to worry about me. What veterinarian will ever want to be "online"? Don't waste your time, stick to your successful academic career. I heard it over and over. But something kept pulling at us. We were going to change the world. In our naive state we figured we'd be done bringing everything ever needed online by 1995. Fat chance!
Around 1993 the World Wide Web began to entangle our lives with www.YouNameIt.com. Initially it was all information and then it seemed to be all commercial advertising and now it seems to be finding a balanced mix. At the same time VIN released its first online database seeded by the Quarterly Index from Veterinary Interface and suddenly veterinarians in practice who owned a computer and a modem could easily access information like never before.
Within a few years, VIN and NOAH both moved to the Worldwide Web and the limitations of whether you belonged to America Online, Compuserve, or Joe's online service were removed.
Today, faster internet access speeds and more affordable computers in nearly all veterinary practices and the recent explosion of powerful PDAs ensure that we are only seeing the beginning of the use of information technology tools in practice.
The birth of telemedicine services such as Remote Veterinary Consultants, DVM Communications and many more (Sound Technologies, Veterinary Diagnostic Imaging & Cytopathology, Darkhorse Medical Ventures) in recent years have expanded the frontiers begun by Cardiopet. The same concerns about quality vs. quantity remain. But there is no stopping it now, veterinarians are, and will continue to communicate and transact business, all over the world.
In 1991 many doubted that veterinarians would ever go online in large numbers. Today there is no doubt that everyone is, or soon going to be, online. Like the adoption of electrical power, telephones, radio, television, cable TV, satellite TV, and FAX machines, it is just a matter of time.
But the lesson to learn from these examples of technology we all adopted and the recent dot.com craze is that technologies come and go. But the world stays the same. We have the same needs and desires. The same sound business practices apply to being successful. And veterinary medicine is still about helping animals and the people who love them.
Our principle challenges to success are not going to be changed by a dot.com craze. We will continue doing business people-to-people. We began with face-to-face interactions using paper forms and advanced to telephone and fax as principal communication and ordering processes. This occurred while not eliminating face-to-face interactions. Similarly, email, PDA based, and online transactions will grow as tools for doing business. It is doubtful that they will replace face-to-face, telephone and fax entirely. They are new options for doing the same thing we have always done. Hopefully with improved efficiency.
We will adopt them as fast as makes sense and human behavior can accept them. No slower, no faster. There is no such thing as "internet time". There are only people working as fast as they can. Certain changes that make sense will happen as we watch and some change will take the passing of the baton to the next generation to be accepted. We know change is coming. And it is exciting. Hopefully that change will bring solutions to some of our greatest challenges. But for the moment we still have lots of work to do.
So while you are using your practice computer as a fancy cash register, consider how we can work together to enhance our profession by finding solutions to some of our largest issues:
We are geographically diffuse - there are not many of us and we are not well organized or coordinated.
We don't have a good plan for raising our young - we have no requirement or standardized plan for post-graduate training.
We have limited numbers of specialists with limited ability to reach many colleagues who desire their services.
We operate small businesses in competition with each other and lack the power to negotiate effectively with our suppliers.
We have focused too much on product sales above service provision.
We don't charge enough for our services.
We have limited resources (people and dollars) for objective research. Therefore, in the midst of an explosion of new publications and textbooks, we operate in a relative information void. We need faster ways to generate and distil objective information.
We have not adequately fostered veterinary support professions as profitable and satisfying lifelong career goals.
Undoubtedly, technology will contribute to the resolution of some of these issues, but more than technology, solutions are about people: You and all your colleagues who live and work together in your practice, in your communities, and beyond.
From the perspective of this nongeek, early adopter - easy access to current information and connecting with colleagues and the resulting sharing of ideas and information are the primary benefits we as a profession have thus far derived from recent advances in technology. See you online!
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