Small Animal/Exotics20TH ANNIVERSARY
time is 24 hours, the value of tele-medicine to many practitioners isprobably lost.Learning to use software programsis fairly straightforward. Familiarity with Windows 95 or 98 is essentially all users need to have. Practitionersunfamiliar with Windows 95 or 98may initially have difficulty; howev-er, the programs are user-friendly andeasy to master.
The cost of telemedicine opera-tions depends on practitioner needs.To transmit patient records and sim-ple images (e.g., skin lesions), practi-tioners need a digital camera, an IntelPentium
computer, access to the In-ternet or standard telephone lines,and telemedicine software (TableTwo). This camera/software/hard- ware package would cost between$5000 and $10,000. Including a top-of-the-line mounted digital camera(Table Three) and viewbox for cap-turing radiographs will add about$3000. A radiograph scanner willcost between $10,000 and $25,000,depending on the manufacturer andfeatures. New ultrasound equipmentpurchased at the same time will costfrom $14,000 to $35,000 or more.Telemedicine consultation feesrange from $25 to $75 per case. Car-diology and internal medicine con-sultations may be more expensivebecause the information to be inter-preted is more complex than that forinterpreting radiographs or cytologicsamples. Practitioners generally add50% to 100% of these fees whencharging clients. However, clientscould actually spend more on officevisits to specialists because travel-re-lated costs must be added to referralfees.Telemedicine software will contin-ue to improve, but the ongoing coststo practitioners will not become pro-hibitive. Today, computer hardwarelasts approximately 5 years, and prac-titioners always have the option of
Profit Projections for a Fictitious Clinic
Specialist fee for internal medicine cases:$350/case Average number of cases referred:3/monthRevenue:$1050/monthSpecialist fee for oncology cases:$650/case Average number of cases referred:2/monthRevenue:$1300/monthSpecialist fee for cardiology cases:$450/case Average number of cases referred:3/monthRevenue:$1350/monthSpecialist fee for dermatology cases:$250/case Average number of cases referred:2/monthRevenue:$500/month
Projection of increased revenue with telemedicine$4200/monthProfits generated (total increased revenue)$50,400/year with telemedicine
Caveats of Veterinary Telemedicine
As with all technologies, veterinary telemedicine has some weaknessesthat need to be resolved, including the following well-known caveats:
Initial quality of radiographs—
If a radiograph is poorly exposed fromthe initial flat film, the image quality can only be computer-enhancedby about 5% when changing contrast and brightness.
Digital cameras and scanners
The images captured by digitalcameras are inferior in quality to those of scanners. Image quality canalso be affected when the zoom, aperture, and focus functions on digitalcameras are not properly used. At present, scanners are the preferredmethod of capturing quality images.
Eventually, digital radiography will makescanners obsolete because it eliminates the need for radiographic filmand screens. With digital radiography, images can be created and storedsimilar to how a digital camera stores a picture to be downloadedto a hard drive. Digital radiography also will eliminate the need forradiography processors. Once this technology is available on theveterinary market, however, the equipment will be very expensive.
Image capture card
Less expensive cards create poorly definedimages; practitioners should invest in good-quality cards.
The effectiveness of telemedicine depends on theresponse time of the specialist and the telemedicine software provider.
DICOM (digital imaging and communications for medicine)compatibility
Most current telemedicine software is not DICOMcompatible. DICOM, a standard protocol used in human medicine,manages medical images by allowing one software system toautomatically read another without relying on conversion software. At present, telemedicine software is proprietary, which prohibits theability to read other software programs.