| This article first appeared in Trends magazine, April 1985. It is reprinted here as Trends celebrates its twenty-fifth anniversary. |
Today, in 1985, as we look at Dr. Adams and his use of a computer in his practice in 1989, we marvel at the possibilities the future holds. And yet, all of the uses of Dr. Adams’ computer are available technologically today. We have not yet begun to tap the vast amount of resources a computer can provide.
Most veterinary practices utilizing a computer today limit its use to a generally available list of business applications and, in some cases, medical records. Although there are many additional applications for which a computer is ideally suited, there are relatively few, if any, additional software programs generally available to the veterinary profession which would increase a computer’s utilization and productivity.
And while most computers in veterinary hospitals today can be used to access commercial databases and networks, those sources generally do not provide information specific to the needs of the small animal practice. The establishment of a central veterinary network is an exciting concept. Possibilities for information available through such a network include items such as a diagnostic assistance program, drug formularies and information, practice management financial data analysis, computer-based training and computer-assisted instruction, veterinary continuing education and general information bulletin boards, literature abstracts, demographic and economic information, and medical/ diagnostic statistics.
It is a beautiful spring morning in early May, 1989, as Dr. Adams pulls out of his driveway and heads for his small animal practice. This morning he is thinking about computers. He had purchased a small popular brand personal computer in 1983 and had used some readily available business software to manage his income and expense reports and to generate mailing labels for his client newsletters and reminders. That first computer had served as a good learning experience for him. It had helped him become computer literate and had introduced him to the many potential benefits of computerizing his practice. By 1985, it became apparent that he was ready for a more sophisticated computer system for his practice. In late 1985, after much study and research, he purchased a complete veterinary computer system.
That initial system enabled him to computerize appointments and office scheduling, vaccination certificates and reminders, pricing, patient database, medical records, inventory, word processing, and several other functions. Although he had added a good deal of equipment and software programs since that time, the initial purchase represented the largest step in terms of outlay of capital and in staff adjustment and training. His decision to invest in a computer system was aided at the time by an Economic Justification Model, provided by the American Animal Hospital Association. By answering a series of questions about his practice, the Economic Justification Model helped him determine what his needs were, what cost he might expect, and what his return on investment would be. After his computer system was installed, he found, as had his colleagues who had computerized earlier, that his investment returned great dividends in terms of a more effective reminder system, elimination of giveaway items or lost charges, and inventory control.
Reflecting now on that decision to computerize three and a half years ago, Dr. Adams realizes that the decision to purchase would have been worth it even if he had never expanded his system. At the time of his initial purchase, he never dreamed of the many functions his practice computer would one day perform. His vendor, a participant in AAHA’s Certified Computer Vendor Program, has offered new program usages steadily for the past three and one-half years. Although Dr. Adams had not elected to purchase all of the new programs offered, he had purchased a good number of them. Each time, the AAHA Economic Justification Model program provided him with guidance for his purchase decisions.
As he pulls into the parking lot of his hospital, Dr. Adams smiles in satisfaction. After greeting his staff, he sits before the computer terminal on his desk. A few key strokes and two windows appear on his terminal screen. On the left is a list of telephone messages waiting for him. The window displays the caller’s name, the time the call came in, a brief message, and the telephone number. The first message is from Mrs. Wilson, with a question about continuing medication for her cat, Banjo. Another few key strokes displays Banjo’s medical record file on the right hand window. He reviews the file, calls Mrs. Wilson, and notes the call on the record, authorizing a refill of Banjo’s medication. (Later Mrs. Wilson will pick up the prescription; the receptionist will bring up her record and, with the proper commands, have a computer-generated label printed, a price determined, and a receipt generated. The amount of medication will be subtracted from the hospital inventory record.) The second call is from Dr. Adams’ accountant with a question regarding a ledger entry item. He returns the call, brings up the appropriate invoice record in the right hand window, and explains the expense to his accountant. His calls now complete , he removes the messages from the screen and begins to see his morning appointments.
As he sees patients throughout the morning, he notes with satisfaction the many ways the computer is used by his entire staff. His ATs enter medications and fluids administered to hospitalized patients; a receptionist prints reminders for the month; Mr. Roberts, his business consultant, uses a terminal to prepare hospital budgets and forecasts; and his associate, Dr. Benjamin, enters the morning surgical reports into the appropriate patient records.
He notes the speed and efficiency of the system. The various computer terminals located at key positions throughout the hospital are all in use at the same time, although the users are all performing different tasks, without slowing down any of the programs in progress. As a patient enters the hospital and moves through the examination room to radiology, back to the examination room and then to the discharge window, his record follows him and is recalled on computer screens with a single key stroke. Pricing is automatic and accurate. Response time on computer screens is almost instantaneous.
He recalls with pleasure the advantages of his AAHA Certified System. Each time he wanted to expand the number of terminals, computer memory, or software programs, he was able to do so without great expense. Because of the modular and expandable design of the system, he had been able to add components as needed, without having to replace any of the hardware purchased three and a half years ago. Although he has confidence in his vendor and is pleased with the service he receives, he finds comfort in knowing that, because his system meets AAHA computer standards, he could change vendors if necessary without having to change his hardware. Conversely, if technical advances make changing his hardware desirable, he can do so with assurance that his existing software will run on the new hardware. Because his software is written in a language and on an operating system designed to be highly portable, he could update his computer hardware without having to reprogram the software.
After lunch, Dr. Adams finds himself back at his office computer terminal. He enters the portion of his program that he finds most exciting. His software helps him access through a modem the AAHA network. He enters his personal identification number, which identifies him as a member and qualifies him for reduced access fees. Before he can begin, his associate requests time at the terminal to access the Association’s diagnostic assistance program. By inputting patient history, physical examination findings, and lab data about a problem case, Dr. Benjamin receives a list of probable diagnoses, a suggested protocol for confirming the diagnosis, and a list of appropriate references for each diagnostic probability. With a single keystroke, Dr. Benjamin has the information from the diagnostic program printed on one of the hospital’s printers. He can then review the information and formulate his plan for his problem patient.
By now, Dr. Adams is anxious to enter some business management data. By using the AAHA Uniform Financial Management Program, included with his software, he collects financial management data in a manner comparable to thousands of his colleagues. At the end of each quarter, he transmits his data to the AAHA’s central networking facility. In return, he receives a complete quarterly financial report, comparing his data to 46 other equivalent practices (by number of veterinarians) in his geographic region. All of the participating practices receive a similar report. However, all data has been transmitted in confidence, and no participant is able to identify any practice other than his own.
He had noted three months ago that his expense for personnel, as compared to gross income, was much higher than most of his colleagues. A review of past reports demonstrated that where two years ago he ranked twenty-third out of forty-six in terms of personnel expense, his last report ranked him thirty-six out of forty-six. He had been stimulated to adjust work schedules to avoid overtime expense, and when a full-time employee resigned, he replaced her with a 25 hour per week employee. He was delighted to see that for this quarter he had improved his ranking to 22 out of 46.
In the area of average transaction income, Dr. Adams had consistently ranked in the top one- fourth of the group, generally about number eight. Three months ago, he and his staff had set a goal of increasing the average client charge by 5% and had worked hard to reach that goal. He was pleased to see that they had, in fact, improved the average client charge by 6.4% and now ranked number three out of forty-six!
He now accesses the Association’s demographic database. By utilizing data available from the US Census Bureau and other sources, the AAHA had established a database of pet owners. Dr. Adams quickly receives, via his telephone connection, a printout of the number of pet-owning families in the two zip code areas served by his practice. Further, he is able to predict the number of pets by species, and to compare it to the number of pets from the two zip code areas currently in the active files of his practice. From this information, the data suggests he is serving 31% of the pets in his practice area. If his nearby colleague, Dr. Jones, is serving the same number of pets, he calculates that up to 38% of the pets in his practice area are not seeing a veterinarian regularly. A few quick calculations will help him determine the possible return on a direct mail marketing campaign to homes in his practice area. He makes a note to invite Dr. Jones to lunch to discuss the possibility of a joint marketing approach.
Next, he accesses the Association’s information section. He searches the list of available Continuing Education offerings in his area, finds a meeting on orthopedics (his area of interest) in a nearby city, and with a few quick key strokes, registers for the meeting and charges his registration fee to his bank credit card.
Finally, he notes the availability of a new computer-assisted instruction program for veterinary technicians. By sitting in front of a terminal screen, his technician can take a review course in anesthesia administration and monitoring. A few more key strokes transfers the computer-assisted training program to his computer, where he transfers it to a floppy disc for use at a later date by his technicians.
During afternoon appointments, Dr. Benjamin admits a patient, a Labrador retriever, with a high fever of unknown origin. After drawing samples for urine analysis, a complete blood cell count, and a biochemistry profile, Dr. Benjamin orders the patient started on broad spectrum antibiotic therapy. Following a surgical preparation and utilizing only a local anesthetic, he then implants a small sensing device under the skin in the left axillary area. The sensor, measuring approximately 1.5 by 1.0 by 0.5 cm, will monitor the dog’s temperature. Dr. Benjamin then orders his patient placed in a cage closest to a receiving unit mounted on the wall of the ward. Using one of the computer terminals, he then programs the receiver to signal the computer if the patient’s temperature goes above 104.5 F. In the event that the dog’s temperature exceeds that point during the night, the computer automatically will dial Dr. Benjamin’s home telephone number.
Before leaving the hospital at the end of the day, Dr. Adams makes sure that the computer is properly monitoring the security system of the building. Sensors on all doors and windows, motion detectors in the office areas, and smoke sensing devices throughout the building all are connected to the computer. Stimulation of any of these security monitoring devices will cause the computer to call the proper fire or police authorities. As he drives out of the parking lot, Dr. Adams again smiles to himself, pleased with the thought that his computer will work all night and will not have to be paid overtime.