Most early reports of implemented World-Wide Web (W3) medical record systems describe single institution architectures. Although these systems address several important needs such platform independence and remote viewing, they do not address persistent needs for integrating multiple legacy record systems. As today's newly minted record system is tomorrow's legacy system, the requirement for a coherent solution to integrating the functionality of these systems without necessarily replacing them will be with us for a long time. W3-EMRS, a multi-institutional architecture seeks to address this challenge. Its motivation, design and implementation will be reviewed and examples of its use provided to illustrate its functionality. Although W3-EMRS solves an important class of problems, several horny problems in data sharing have now become much more apparent now that W3-EMRS implementations are available. These too will be reviewed.

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 Guidance systems which offer an increased precision in surgical procedures have been found to improve patient outcomes. Examples include the implantation of hip prostheses and neurosurgery. The presence of jigs and reference frames is bulky, uncomfortable and awkward for the patient and surgical team as well, constraining the mechanics and access of the procedure. Frameless guidance systems are needed to help surgeons plan exact locations for incisions, define margins of tumors and precisely locate critical structures. We describe an automatic method for aligning clinical image data, such as segmented MRI or CT, with any view of the patient, with particular demonstration on neurosurgery examples. The method enables mixing live video of the patient with the segmented 3D MRI or CT model of concealed internal structures, supporting enhanced reality techniques for planning and guiding surgical procedures. It also supports real time tracking of surgical probes, allowing the surgeon to visualize the surrounding context of the surgical field, thereby supporting more accurate, and more rapid interventions. The system is now in regular use by surgeons for direct guidance and navigation in neurosurgical cases. Our presentation will include a blend of didactic material, slides, 3D image projection and videos of the technology in action.
 

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 Virtual reality and telepresence are widely recognized as key to the future of health care delivery and instruction. They will play an increasingly major role in mitigating the maldistribution of practitioners with specialized skills, provision of care in remote locations or adverse environments and in sharing medical skills and knowledge internationally. Such methods hold particular near-term promise for realistic instruction, practice and evaluation in highly technical tasks; where danger to the patient, limited availability of mentors, public sentiment against use of nonhuman animals and expense of apparatus limit more traditional "on-the job" training. We have built a haptic computer interface device related to the insertion and manipulation of medical catheters. The insertion of such catheters into blood vessels, heart chambers or other body structures is a very common medical procedure. Skill and practice are necessary for its safe and successful accomplishment. The interface device permits the operator to manipulate a real catheter in a realistic "virtual reality" environment with visual and tactile feedback. The ordinary operations attendant upon catheter manipulation; such as insertion or withdrawal, twisting or rotation as well as inflation or deflation of a guide balloon are transformed by our invention into appropriate electrical signals which may be transmitted through the serial port of a computer. This information is then used by part of instructional software for programmed instruction. It may also be used as part of remote delivery of treatment ("telemedicine"). Instruction in insertion of the balloon guided pulmonary artery ("Swann-Ganz") type of catheter,including proper and improper execution of indicator dilution for measurement of cardiac output, is used as a particular practical example. The presentation will include demonstration of the device and software. It will require large screen (projection etc) monitoring with VGA capability.
 

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 The recent growth of online connectivity and interactions leaves little doubt that being "online" will be essential for meeting the demands of veterinary practice in the 21st century. Relationships with distributors of products and information will be affected, changing in the way veterinarians "do business". Of equal concern is how to leverage these technologies to address the evolution of veterinary science. Opportunities for immediate access to online libraries and databases, and rapid dissemination of new information are new to most members of the veterinary profession. As a result, a large segment of veterinarians are, and will be, for the first time discovering how continuing education, informal and formal consultation with colleagues, and standardized mentorship. Similar to how the invention of the printing press catalyzed the end of the Middle Ages and the beginning of the Renaissance, the advent of online communications has greatly lowered the economic, temporal and geographic barriers to organizing, expressing, and effectively disseminating information, political agendas, or dissent. As a result, the classic information channels (e.g., journals, textbooks, university programs, industry communications, and organized veterinary medicine.) will be significantly influenced via integration with online communication and delivery systems. To assist in the transition, it is essential that the on-line experience complement the off-line counterparts. While adopting these technological and paradigm shifts, the veterinary profession will experience a democratization of the process by which we generate new information. With these new opportunities and privileges come new responsibilities and a need to readdress processes for assessing the quality of information being disseminated. The possibilities for growth of our profession are immense if these technologies are appropriately implemented. Improperly implemented, there is potential for (best case) resistance to these changes or (worst case) abuse within our profession. Attention to fostering online community interactions that provide equal representation for diverse segments of our profession will be essential for the rapid adaptation and success.

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 Computer-based clinical decision support systems (CDSS's) for human and veterinary medicine are beginning to demonstrate their value. However, with a few exceptions, these systems operate as stand-alone applications. As a result, CDSS's are not involved in the mainstream medical data gathering process, do not store patient findings in a standard manner for future use, and are simply not used or are consulted after the fact. In order for CDSS's to become truly functional in clinical practice, these systems must be tightly integrated with the electronic patient record. In addition, clinical decision support engines must be operating for the patient's benefit in the reception room, the exam room and during the balance of diagnostic and treatment events. This paper will illustrate how such a system could be utilized to: 1. Improve and speed patient evaluation through a structured interview. 2. Remind the clinician about other history and clinical findings which may provide clues about the correct diagnosis. 3. Suggest possible diagnoses based on current and past medical history and events. 4. Aid in diagnostic planning by suggesting diagnostic tests and/or procedures for rule-in/rule-out. 5. Provide digital images of reference material (e.g. cytologies, radiographs) which can be used for comparison with the current case and for client education. 6. File all collected history, physical exam, laboratory, and special procedure data using a standard medical nomenclature for use during future visits and for conducting epidemiological studies and making electronic referrals. 7. Aid in treatment selection and administration, reminding about drug interactions or contraindications. 8. Prepare custom client take-home instructions. 9. Provide a sound defense in a legal case. The paper will also discuss the challenges and obstacles in the development and implementation of such a system.

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 How often have you been asked, "What should I do doc?" and wished for a way to lay out the options in a clear way for the pet owner? Decision analytic modeling provides a systematic approach to the comparison of possible treatment strategies where trade-offs make the optimal choice otherwise unclear. The basic approach can be manually applied to any decision making the options explicit and the deciding factors clear to the decision makers. This presentation will cover the fundamentals of simple decision modeling with references to the embellishments afforded with computer programming. Key resources for the development of advanced skills will be pointed out. Currently available software will be briefly demonstrated. The technology involves a systematic approach to the construction of a model for the decision under consideration. Graphic representations for the model are easily comprehended. The model graphically takes the shape of a tree in which the branches of the root represent the separate strategies of case management immediately available to the patient. The branching structure of the tree is constructed from the probabilities of each outcome and the value to the decision maker that each outcome represents. The final model then enables a computation referred to as "folding back the tree" that provides a numeric value for each treatment strategy. Like popular "spreadsheet" software, these trees provide an opportunity for sensitivity analyses which can show the relative importance of specific decision factors. Pitfalls in modeling which can lead to erroneous results will be illuminated. A decision model for Feline Corneal Sequestration is used as an example to illustrate principles throughout the presentation. The strategies of corneal scraping, natural disease course, and superficial keratectomy are compared.

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 Case management is a repeating cycle of decisions, actions, and information designed to reduce the uncertainty surrounding a patient's condition. A single iteration of this cycle is referred to as the decision-to-perception chain because it begins with a decision and ends with the perception of the resulting information. The Patient Information Acquisition Model (PIAM) is a generalized representation of the decision-to-perception chain and serves as a framework for a systematic approach to diagnosing the cause or causes of missing or inaccurate information. Each component and activity of PIAM serves to focus the real-world knowledge an individual has of the healthcare organization and its processes on a specific information gathering scenario. Characteristic questions associated with each component and activity of PIAM help diagnose breakdowns within information systems as well as inefficiencies within organizations.

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The advent of comparatively inexpensive hand-held personal digital assistants (PDAs), capable of handwriting recognition has added a new dimension to on-farm record keeping. Our Production Management Medicine (PMM) Section of the Veterinary Teaching Hospital utilizes Claris FileMaker Pro(tm) version 3.0.1, running on a Claris FileMaker Pro(tm) 3.0 server, to maintain all the farm call invoices and medical records for the College's equine field and PMM services. In order to reduce record-keeping errors, bar-coding and portable computers were introduced to assist us on the farm. None of these systems proved to be satisfactory, either being too fragile or too expensive and unreliable. This paper will demonstrate how we have integrated the Apple(r) MessagePad 2000 into our record-keeping system: reducing the number of transcriptions required for data entry, and training of veterinary students in a systematic method using prompt menus to obviate mistakes. The MessagePad 2000 also has the ability to record diagrams on its screen as illustrations which can be incorporated in the permanent medical record. Our intention is to adapt this technology to the Apple(r) e-Mate, which has the additional merit of having both a keyboard and a pen for data entry on its Newton-like screen.

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The CliniPharm system now comprises three major parts, which are all accessible by Internet (http://www-vetpharm.unizh.ch): Part 1: An electronic Veterinary Drug Compendium for Switzerland, equipped with full browsing and multi-search features. This compendium is updated weekly and provides a complete overview of the Swiss Veterinary Drug Market. Server statistics show an amazing number of more than 80 000 accesses over the past 5 months. Part 2: Synopsis of the clinical pharmacology literature on all therapeutic substances with appropriate crossreferences to literature sources (still under construction, no public access yet). This section provides in-depth drug information and is meant to help solve more intricate or less common therapeutic problems. It also provides comprehensive information on drug interactions, side effects, and drug disposition in specific disease states. Part 3: CliniTox - a computer-based decision support system for the management of poisonings in animals. The system provides detailed guidelines for the diagnostic and therapeutic management of a large number of chemical poisons in all animal species relevant to veterinary medicine. Another feature offers an overview of poisonous plants with detailed (color picture illustrated) botanical information, and advice for patient management (still under construction, but major system parts are already www-accessible). Currently, a new feature is being developed which should allow computer-simulations of therapeutic scenarios. The core consists of a pharmacokinetic simulation module and the input maybe patient-specific data, kidney function, drug dosages/intervals etc. On the output side, the system will alert the veterinarian when a selected therapeutic regimen is likely to cause problems (dose cumulation, inappropriate dosage intervals, elimination disorders, drug interactions, side effects to watch out for) and make suggestions for alternative therapeutic possibilities. CliniPharm currently provides most of its informations in german, however an english version seems feasible. - It seems most desirable to set up a global information system for veterinary drugs and poisons.

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We are studying several type of knowledge based systems to aid in the diagnosis of neonatal septicemia in foals. Using case studies from our hospital and deterministic algorithms as one measure, we also compared the diagnoses as given by several different forms of rule based production expert sysetem (one using crisp logic and one using fuzzy logic) and a neural network system that we are developing. We will discuss the generation of the knowledge rules, the neural network organization and the outcomes of each system in handling data on to diagnose foal septicemia. (note: this project is still under development so results are not forthcoming at this early date -9/18/97).

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The Equine Wellness Program of the Production Management Medicine (PMM) section at the Virginia-Maryland Regional College of Veterinary Medicine involves a health schedule that includes annual testing for Equine Infectious Anemia (EIA), semi-annual physical examination, including dental care, vaccinations and deworming. One physical examination per year serves as the medically necessary examination for insurance purposes should the participant elect to insure the individual horse against mortality loss. The examinations, vaccinations and dewormings are intended to be instructional for both participants (clientele and students) and fourth year veterinary students involved in PMM clerkship rotations. With each semi-annual examination, medications (e.g., anthelmintics and vaccines) may be dispensed along with instructions for administration and timing. During each examination, the participants are given instruction in proper anthelmintic administration, vaccine storage, sites for intramuscular injection, proper injection technique, and discussions are held concerning the horse's previous, or continuing, health problems, and their recommended clinical management. In concert with this, we have developed an electronic medical records system (FileMaker(r) Pro application, version 3.0.4), maintained on a FileMaker(r) Pro Server (version 3.0) that serves to uniquely identify clients and their individual horses, and to document medical findings and procedures, vaccinations and dewormings, and further to generate reminders for each participant to schedule their next appointment or procedure(s) due. PMM students are instructed in generation and maintenance of an electronic medical records program, and are responsible for its day-to-day posting of new information, generation of reminder notices, and scheduling of appointments during their respective PMM clerkship rotations. The information is available within the University intranet by secure access for review and updating by Hospital clinicians. Clients may access their animal's record over the internet using any one of the more common web browsing applications (e.g., Netscape(r) Navigator, or Microsoft(r) Internet Explorer).

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The Veterinary Medical Teaching Hospital (VMTH) at UC Davis has made pertinent information in the clinical database available to veterinarians via the Web. Referring veterinarians are now able to select from a list of cases (visits) they formally referred to the VMTH, as well as cases for which they were identified by the client as their local veterinarian. These visits are displayed in reverse chronological order with modest identifying information associated (patient name, breed, client name, date of visit, etc.). If a visit which has not been finalized yet, is selected, only demographic information (to include the VMTH's primary clinician) is displayed. If a finalized visit is selected, however, a full battery of clinical information is made available to the referring veterinarian. This includes: presenting complaints; pertinent history; physical examination findings; inter-service consultations; problems noted; medical, surgical and diagnostic procedures performed; laboratory results; imaging reports (radiography, CT, MRI); pathology reports; pharmacy dispensations; clinical diagnoses; pathological diagnoses; plans and progress notes; discharge summary; and discharge instructions. The Web display enables the user to scroll through the entire visit summary, or to select the sections of immediate interest. This availability of comprehensive and timely case information has further strengthened ties to our referral community. The Referring Veterinarian module provides "read-only" access to the visit summary and associated clinical information, but a similar module, offering "read-write" access to the visit summary, is provided to VMTH clinicians and students until the visit status is changed to "final". This facilitates remote (primarily office or home) review and entry of clinical information into the VMTH database.

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The objectives of the current project were to 1) identify limitations, if any, of search precision and recall for free-text surgical diagnoses included in electronic patient records maintained at the University of California, Davis, Veterinary Medical Teaching Hospital (VMTH), 2) develop procedural or programmable recommendations for removing these limitations, and 3) provide guidelines for effective search strategies for users performing aggregate searches using the VMTH clinical information system. Search recall corresponds to detection sensitivity, or the capacity of a search term to signal a relevant document, and search precision corresponds to search positive predictive value, or the proportion of retrieved documents that are relevant. Horses submitted to the VMTH for a gastrointestinal (G.I.) disorder requiring surgical intervention from January 1, 1995 through December 31, 1995 were identified with procedure codes used for billing purposes and stored within the electronic patient record. Patient records and surgical reports were reviewed to determine cause of G.I. disorders, and variation in expression of these disorders. Searches were performed for four G.I. disorders, and search performance was evaluated by estimating search recall and precision. Search recall ranged from 33% to 98%, and precision ranged from 2% to 74%. The procedural recommendation that would likely have the greatest influence on minimizing these search limitations would be a movement towards uniform expression of G.I. disorders. This would free searchers from having to imagine and anticipate all of the exact words and word combinations that could be used in the relevant documents, and only in those documents.

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The purpose of this research is to investigate the use of electronic bibliographic databases by clinical veterinarians, and the impact of information derived from searches of databases on clinical decision making for patient care activities. Reasons for the search and impacts of the information obtained from the search are classified into three taxonomies. The three taxonomies are derived by using a qualitative analysis of data gathered during interviews with clinical veterinarians. The qualitative analysis used in the research is based on a grounded theory approach that employs a constant comparative method for deriving the taxonomies.. The three taxonomies are: 1. reasons why information was sought from electronic bibliographic databases; 2. assessments of clinical veterinarians of the impact of information derived from electronic bibliographic databases on patient care decision making in prevention, diagnosis, and treatment tasks; and 3. the ultimate impact of finding (or not finding) the information derived from the use of electronic bibliographic databases on the outcome of the patient care situation that prompted the search. A model of the information search process for clinical veterinarians is proposed from the derived taxonomies. The model describes a synergistic relationship between motivation to use electronic bibliographic databases for patient-care tasks, the use of information derived from databases in problem-solving and decision-making activities related to patient care, and assessments of clinical veterinarians of the impact of information derived from search of the databases on patient-care outcomes. The model also views the information search process as an iterative process that is based on positive assessments of the quality of electronic bibliographic databases and the information products obtained from a search of the databases. The model also demonstrates that clinical veterinarians have positive assessments of electronic bibliographic databases despite significant barriers to the effective use of such databases, because of their perceptions that the information derived from the search was useful to the final outcome of the patient-care situation that prompted the search.

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Program Description The Veterinary Technology Distance Education program uses computer communications technology to serve students who cannot attend on-campus courses due to distance or time conflicts. Faculty and students use email, bulletin boards, and weekly real-time group conferencing online for each course. Electronic communications are through America Online and Veterinary Information Network. The lab courses also require students to work in veterinary offices at least 20 hours per week. The faculty provide descriptions of lab skills and the evaluation criteria to students and clinical supervisors. The veterinarian employer and staff teach and evaluate the students in preparation for written and practical final exams. The Distance program meets the educational needs of hospital employees who must work full time and who cannot move to St. Petersburg or other veterinary technican programs to attend college. A class of sufficient size can be made up of students too geographically distant and isolated to meet face to face. It meets the needs of veterinarians by enabling employees to upgrade their skills and knowledge without leaving the job. The Distance Education program also has significant potential to address the shortage of graduate technicians which worsens each year. The program began in 1994 and has approximately 140 students currently enrolled from Florida and 20 other states. The first graduates finished at the end of summer session in 1997.

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In the Spring semester of 1997, WSU, offered its first WEB-based clinical problem solving course in the DVM curriculum to WSU and Kansas students. The course was designed to provide an opportunity to solve clinical problems, allow students freedom to make decisions and mistakes without jeopardizing the welfare of a real patient and to provide an opportunity to review basic science concepts as related to the clinical problem. The course can be accessed at: http://www.vetmed.wsu.edu/academic/courses/vm499_97/index.htm The students worked on the cases as small groups. From the main menu, select "student logins". Click on a group number, then on the name of a patient. Because students at KSU participated on a non-credit basis, they did not participate in each of the 4 cases and you may encounter a case that contains no student input. The students requested additional data by email or from a web form at the end of their web page (the process evolved as the semester progressed). The requested information was posted back to their group's WEB site. The normal type is the student request (including mis spellings). The bold italicized type is the instructors reply. For the early part of the case work-up each group worked in their own web space. Later, all student's could access each other's web space to see how other groups were managing the same case. At the conclusion of each case the instructor posted a case summary. The summaries were discussed with KSU students as a text-based discussion in a chat room or via a conference telephone call. At the present, the chat room is not functional on NT and will require modification to run on this platform. I am proposing to present this class as an example of a format that could be used as a distance continuing education program for practicing veterinarians.

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 There is a need for improved delivery of instruction in endoscopic techniques to veterinary students. An interactive, computerbased program was authored with commercial software (Authorware 3.51) to create a series of lessons on small animal gastrointesuinal (GI) endoscopic procedures. Individual lessons review pertinent anatomy, clinical indications, patient preparation, normal mucosal appearances, abnormal mucosal appearances, and biopsy technique for endoscopic examination of the esophagus, stomach, small intestine, and colon. Organization of the program is centered on endoscopic examination of individual organs. Over 250 GI endoscopic images (with accompanying patient, radiographic, and histopathologic images) were scanned (Nikon LS 3510-AF slide scanner and associated software) and digitally mod)fied (Photostyler 2.0) prior to importing them into Autho~ware files. Students are able to move within and between endoscopic procedures by button clicking on appropriate icons. Learning activities are reviewed in an interactive self-assessment format by asking the student to respond to a series of procedural questions or to correctly identify various endoscopic images. This program will be developed for cross-platform (Mac and Windows) use and has been placed on the college server and written to CD-ROM. Ready access to a GI endoscopic techniques computer program by students and faculty will permit greater efficiency and consistency in instruction.

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 Teaching the principles of veterinary clinical anesthesia has traditionally relied heavily upon live animal laboratories and supervised management of clinical cases. The laboratories typically involve anesthetizing a research animal, instrumenting the animal, and observing responses to various anesthetic drugs and/or surgical approaches. The recent movement away from animal-intensive laboratory exercises has necessarily reduced the student's exposure to a variety of differing situations that frequently occur in the practice of clinical anesthesia. The principles of mechanical ventilation are difficult to grasp for many students without some type of "hands on" experience. The Virtual Mechanical Ventilator Application was designed to demonstrate the function and interrelation of a mechanical ventilator's controls, and the effect of the ventilator settings on the patient's respiratory physiology. The Virtual Ventilator Application was written for Win32 operating systems using Visual C++ and the MFC framework. The Application takes advantage of Win32 features such as multithreading and true C++ exception handling. The Application will be evaluated in a laboratory setting as it replaces a live animal anesthesia laboratory.

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The tools used to digitize images and sounds are now sophisticated enough for good results to be possible without breaking the bank or being a technophobe. Using digital cameras to record case material opens new avenues to the practicioner. Storage, communications, consultations, client education and followup is changing as these avenues are expanded. We will share our experiences in using several digital tools to capture clinical case pictures, radiographs, text and sounds, and to manipulate them, store them and assemble them for local display or transfer across the internet. While we have found the MacIntosh to be easier to work with, similar tools are used in the Windows environment with similar end results. The tools used are digital cameras, slide, flatbed and radiograph scanners, video cameras, digital video cameras, video digitizers, audio digitizers, image and sound manipulation software and authoring software. A brief overview will be given of the best and worst of these, with a view to getting the neophyte started. The capabilities of the tools will be illustrated with case material and client education programs constructed from images collected from patients in our hospital. The limitations, cost and time associated with this process will be covered, with some insights into the possible uses that could come from an investment into digital imaging by the practicing veterinarian.

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Most telemedicine projects involve two-way communications which may require specialized equipment and expertise at both sites. We believe there are many other applications in which we could provide improved service to our clients using a simple one-way telemedicine approach which requires specialized equipment at only one site. The only equipment required at the remote site would be a computer with internet access. That is the approach we are taking in a pilot project we initiated in 1996. Mail-in cytology samples have traditionally been received in our clinical pathology lab. We have modified our traditional procedures to capture the microscopic images directly from the microscope using an RGB television camera. Within minutes of receiving the sample we can have an HTML file with the images posted on our WWW site for examination by the practitioner who submitted the sample. The participating practitioner may access the information using a unique name and password. A demonstration of this technique is available at: http://dbweb.vetmed.auburn.edu:8080/results/clinpath/guest/tiger/ In this example the practitioner name is "guest," and the password is "tiger." Select the case number, and then select "first.htm". A 24 bit color graphics card is needed for acceptable quality. We are also considering another approach in which the practitioner prepares the images and transmits only the image to the diagnostic lab. This would require additional equipment at the remote site. Perhaps more importantly, it also would require considerable expertise at the local site in finding the relevant fields for examination and in preparing a diagnostic quality image. The presentation will describe the techniques used for capture, incorporation into the college's clinical database, and preparation for access from the remote site. It will also discuss some of the issues we must address to assure that we are providing an accurate diagnosis.

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 Goal: To outline the importance of telemedicine in the veterinary industry, and its usefulness in determining the availability of even greater levels of patient care today and in the future. The concept of telemedicine needs to be defined within the context of its applicability to the veterinary industry given the constraints of cost benefit analyses. The equipment which dominates these cost constraints should be demonstrated including all facets of a complete diagnostic work-up involving active specialist participants. Conference attendees should leave with a solid understanding of how current, cutting edge technologies can be successfully applied to everyday practices with a positive result to the practice. Demonstration: The discussion would begin with "why telemedicine?" ( Increase patient care, increase client education, increase revenue) The discussion would also include the benefits of Internet vs. Point to Point communication as well as the significance of compression and archiving. DVM Communications will organize a group of equipment vendors which it considers to be the most forward thinking in the field of diagnostic imaging. The most exciting diagnostic processes in the telemedicine revolution are ultrasound, radiograph interpretation, and video image capture enabling transmission and archival of dermatology, ophthalmology, and cytology to name a few. DVM Communications will assemble this equipment on an integrated cart. A complete diagnostic work-up will have been preformed on an actual patient. Different components of the case will be instantly sent via the telephone hook-ups made available. Specialists will be on hand electronically to interpret the case and render the results. After the symposium, each vendor will hold a wet lab to further demonstrate how their systems work and how they integrate seamlessly into a telemedicine package via standardized video and digital signals. DVM will provide a minimum of a Pentium II processor with 128 RAM on its integrated cart. Other demonstrators ( such as New England Medical's video guided surgery techniques) may use the computer system. Scientific Format: DVM Communications is aware of the scientific structure of the symposium and will honor the integrity of the organization. DVM Communications will not structure its presentation as a commercial demonstration rather it will present the virtues and capabilities of telemedicine. It's DVM Communications' belief that the more the industry understands of telemedicine, the more the industry will embrace it.

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 I would like to present from a practitioner's point of view, how telemedicine will assist the daily practice routine and how it will generate additional practice revenue. Clients do not want to have to leave their veterinarians' practice and go somewhere different and foreign. What can be teleported? Does telemedicine shorten the ultrasound learning curve? How do you market telemedicine in the veterinary practice? Quality control issues.

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More than ever, medicine is fueled by information. The amount of information is overwhelming, however, and it is impossible for busy general practitioners to keep current with advances in all fields. Telemedicine could provide an answer to this problem--if designed and applied correctly. At Veterinary Diagnostic Imaging, P.C. and Veterinary Cytopathology we have provided teleradiology, telesonography and telecytology services nationwide for two years (approximately 1,500 consultations) using four different telemedicine systems. The purpose of this presentation is to share our experiences and thoughts on how to make telemedicine useful and profitable at both ends of the telephone line. The discussion will describe how veterinarians can use telemedicine to incorporate specialists into their practice. Additional topics will include how telemedicine can be used to save time, be more efficient, gain a powerful competetive advantage, acquire and keep the best clients, attract and keep the best veterinarians, take medicine to a higher level, provide more services, enhance the image of the practice, and make more profits. There is a lot more to successful telemedicine than new and exciting technology. Telemedicine is not a success when an image is transmitted, but when one takes full advantage of this quick transfer of information.

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