There are very few veterinary clinics where the people working in them do not use multiple pieces of software on a daily basis. The main ‘brains’ of the practice is the practice management system (PMS). The most common PMSs in the UK are made by Covetrus (Ascend, Robovet), NordHealth (Provet Cloud), Idexx (Animana, EzyVet) and MWI (Merlin) among others. There is a new breed of PMSs such as Digitail and Vetspire that are less common in the UK, but are bringing innovation to challenge the status quo.
As well as acting as a place to store client and patient information, a good PMS should connect well to other pieces of software and services in order to help the clinic to optimise their workflows and improve their productivity. There is an old saying that the one thing a vet hates more than their PMS is changing it. This is probably the main reason why some clinics use PMSs which rely on having a server sitting under a desk somewhere. One wrong turn of the receptionist's chair and it might be lights-out for the whole clinic as the power cord is pulled.
More modern software, however, usually lives in ‘the cloud’, which basically just means they run on a whole load of servers in a server farm somewhere. There isn't yet an adage for this, but one other thing that people working in a clinic generally don't like is having to run 20 different software applications, each with a different username and password, simply to get their daily tasks done. That is why over time, the PMS started to become a behemoth, trying to do all sorts of functions that were perhaps a little ambitious. It now manages stock, invoicing, payments, messages, reminders, bookings, lab reports and almost every other function you can think of. In other industries it is perfectly normal to use a few different (but well integrated) tools in your daily work life.
As we catch up in the veterinary world, what we are seeing is the evolution of veterinary PMSs into two main categories. There are those that are still trying to do it all themselves, some of whom have managed to raise lots of investment (such as Digitail), and there are those looking to become a platform. In the same way as you may use the Apple App Store or Google Play Store, PMSs can act as the platform and other companies can come in and integrate with them.
Customer-facing tools
The earliest forms of integration were internal tools such as lab machines talking to the PMS, but there is now big growth in customer facing integrations. These started with online booking tools such as VetBooker and Vetstoria. An online booking tool helps to expose some or all of your calendar to allow clients to book appointments. Some, like Vetbooker, act as a full client portal, where a client can view their and their pets' details, such as contact information and even patient history. From there the client can keep their own information updated and stay informed about things like product reminders. This record management coupled with online bookings act to reduce phone calls and emails, and allow customers to self-serve. This takes the pressure offof already busy receptionists and nurses who may be manning the phones.
While online booking is almost becoming ‘table stakes’ now for clinics to offer, it only partially solves the issue of busy phone lines. One challenge is that clients don't actually know what to do when it comes to booking in anything that isn't a very simple check-up. If their pet is ill, they usually want some sort of advice, as well as specific guidance as to what they need to book, when they need to book it for, who they should book it with and how much it might cost. While there are exceptions, even active clinics with engaged clients tend to see less than 20% of appointments booked online. Recently, other software solutions have become available that help to solve these issues of giving customers the help and guidance they want, without them having to resort to a phone call. Asynchronous communication – essentially the act of sending digital messages to and from the clinic (Smiley, 2022) – has increasingly found its place in the toolkit of forward thinking clinics. As the vast majority of queries are not urgent, and it is operationally inefficient for both client and customer to be available at the same time for a phone call, allowing clients to send a message into a clinic and then wait for a reply is increasing in popularity. The main tools for this are Digital Practice and PetsApp. Digital Practice integrates with existing messaging apps that people have on their phone such as WhatsApp, whereas PetsApp is a specific client app that your clients are encouraged to download (although they can also use old fashioned SMS without needing the app).
To app or not to app
One thing to be aware of with apps is that while they can seem shiny and exciting at first, our veterinary clinics are not nearly as front and centre in our clients' minds as we may think they are. Whilst some very bonded clients may download and keep an app to interact with you, the evidence suggests most customers in other sectors neither want nor keep specific apps for specific functions. I suspect I am not alone in having been forced to download about 15 different parking apps and begrudge every time I have to download (or redownload) another one just to perform a really simple function.
We need to be careful not to add barriers for our customers while trying to improve their experience, and in this respect optionality is key – give your clients the opportunity to communicate on existing channels they use every day and if you have a particularly bonded client base then an app focused on them may also benefit you. It is also worth noting that web applications can perform (almost) every function of a true native app, with much lower barriers for a customer.
Internal software
It is important to remember that we can't solve problems in our process simply by purchasing a tool. The tool requires engagement on both sides, and there is a certain critical mass of customers you need to engage before a tool becomes really valuable to a business. Until that critical level of adoption you tend to end up adding rather than removing processes for team members in the clinic. The risk is that it becomes ‘one more thing’ and doesn't end up improving work life for everyone.
There are other internal pieces of software that a lot of clinics engage with, and imaging is a one that is easy to forget. Innovations here mean that ultrasounds can now be performed with wireless probes that connect to an iphone (Clarius) and the screen can even be shared with someone else to get another pair of eyes on those fuzzy grey dots. If that is not enough, there are services that offer teleradiology and teleconsultations with specialists such as VetCT. Some clinics have also embraced tools such as Talkatoo, which help with note taking by transcribing from dictation, and there are written clinical notes applications like Kiroku that aim to speed up the process of writing notes.
Artificial intelligence
No discussion of software nowadays can ignore the arrival of artificial intelligence (AI). This is a huge topic, as well as a debate as to exactly what AI is, but it is large language models like ChatGPT which have caught everyone's attention. They have made great strides over the last 12 months or so, dazzling people with their ability to answer questions and understand context. There are PMSs and tools (Digitail and Petsapp for example) that integrate AI into their application, although we are still some way from these tools being commonly used by most people. As I write this article, Google is offering me an opportunity to have AI ‘improve’ it, and I am also offered an email writing service among other things. However, more often than not, even for simple tasks, the AI writing sticks out like a sore thumb and either needs correction or editing to fit my tone of voice. This is very much a ‘watch this space’, however these tools are only likely to improve and will become progressively more mainstream.
As well as AI that you directly converse with, we will increasingly see AI being used behind the scenes with the tools that we use. PMSs will start to surface information they think are relevant as you interact with the system. This may be drug information, reminders or information about a patient, or possibly even systems that you never see which help to manage stock and orders. In further removed environments, AI will also aid with new drug development (Paul et al, 2021) as well as analysis of large data sets such that we see an acceleration in the industry as a whole.
Conclusions
Despite all the uncertainty around just how revolutionary AI might be, one thing that is clear is that we in the veterinary industry are only going to consume and interact with more software over time. Some of this may be invisible to us, and some may change the way that we work and interact with our customers and patients. The pace of change is only increasing, and having a robust cloud-based PMS at the core of your clinic's IT system is going to be the best way to have a solid foundation and ensure you can use all these amazing new tools that emerge.
KEY POINTS
- The main ‘brains’ of the practice is the practice management system. z Record management coupled with online bookings can act to reduce phone calls and emails, saving time in the practice.
- We need to be careful not to add barriers for our customers while trying to improve their experience.
- Despite all the uncertainty around just how revolutionary artificial intelligence might be, one thing that is clear is that we in the veterinary industry are only going to consume and interact with more software over time.