30 October 2024

5 minute read

By: Chris Wright

North America

Editor's note: The following is from a presentation by M.B. Petersen, DVM, MPH, PhD and L.A. Karriker, DVM, MS, ACVPM, Swine Medicine Education Center, College of Veterinary Medicine, Iowa State University, during the 2024 James D. McKean Swine Disease Conference. 

Adoption of telehealth (an overarching term encompassing remote healthcare, education and health information) in human and veterinary medicine was expedited by the Covid-19 pandemic, with many temporary legislative changes in the US allowing for telemedicine (remote diagnosing and treatment of disease) to be utilized to safely provide medical care while allowing for physical distancing.

In veterinary medicine, telehealth techniques are commonplace among specialties such as radiology and pathology, with an increase in telemedicine use within an existing veterinary client-patient relationship.

Telehealth is an all-encompassing term for technologies used to deliver a variety of healthcare, health information and health education services. Telemedicine specifically is the healthcare component of telehealth that includes diagnosis and treatment of disease. Veterinarian-to-veterinarian telehealth consultations have become commonplace in veterinary medicine, allowing general practitioners to consult with specialists (radiology and pathology).

Direct-to-consumer veterinary telemedicine is less widespread, in part due to legislation around the use of telemedicine. In veterinary medicine, the use of and the regulatory landscape around telemedicine is rapidly changing. The current US federal veterinary client-patient relationship does not allow for consultation solely via electronic means.

Foreign animal disease response

While telehealth is commonly used in veterinary medicine and swine medicine, there is little documented research investigating the capabilities and limitations of telehealth technology as it compares to an in-person visit. In swine medicine, telehealth may aid in a foreign animal disease (FAD) response by rapidly bolstering sample collectors, providing veterinary care to underserved areas, and increasing the caseload for veterinary students. Evaluation of these potential use cases for telehealth in swine medicine is critical to allow veterinarians to effectively use telehealth to supplement their swine practice.

Bolstering the number of sample collectors available in a FAD outbreak will be critical in understanding the extent of the outbreak, and telehealth may aid in this response. Transfer of a clinical skill via virtual instruction (telehealth) on a live animal has not been documented to the authors’ knowledge.

Oral fluid collection

To evaluate telehealth as a means of transferring clinical skills in swine, naïve students were trained either in person, via virtual instruction using a tablet, or via virtual instruction using smart glasses on both oral fluid and blood collection. Approximately half of the students sampled nursery sized pigs (manually restrained for blood collection) and half sampled finishing pigs (snared for blood collection).

Most of the students in all groups were successful in collecting blood and all students, regardless of training method, were successful at collecting oral fluids. No significant differences in ability to collect the sample were detected across training methods. For blood collection, students trained on nursery pigs were significantly more likely to collect the sample than those trained on finishing pigs, regardless of training method.

Site evaluation

Evaluation of farms and pigs via telehealth may allow for more efficient use of veterinary resources. To investigate telehealth for site evaluation, 20 wean-to-finish sites were visited via live, synchronous telehealth consults using either a handheld tablet (standard telemedicine package), or smart glasses (specialized telemedicine package). For the site evaluation, the telemedicine evaluators assessed objective criteria under the categories of records, ventilation, feed, and water. Over 90% of all criteria assessed in the site evaluations via telemedicine were considered correct interpretations based on on-farm confirmation.

Pig evaluation

To compare in-person to telehealth for pig evaluation, the 20 wean-to-finish farms were visited both in-person (on-farm) and via live, synchronous telemedicine consults using the handheld tablet or smart glasses. Both in-person (on-farm) and telemedicine evaluators recorded clinical signs and a standard health assessment of the pigs, which were then compared.

Agreement between in-person (on-farm) and telemedicine evaluators was, for all clinical signs, relatively low (13/70 consultations). However, there was agreement with and for all telemedicine evaluations when clinical signs of less than 5% prevalence were removed from the data.

“New” or “additional” clinical signs were listed frequently by both in-person (on-farm) and telemedicine evaluators, indicating significant variability between veterinarians in the interpretation of clinical signs, regardless of the evaluation method.

Color limitations

Since clinical signs are both subjective and dynamic (changing over time), an evaluation of objective data transfer via telehealth is needed. The first two research studies identified that color transfer may be a limitation to current telehealth technologies. Additionally, color is an important characteristic when evaluating lesions during a physical examination or post-mortem examination.

To understand the color transference capabilities of telehealth technology, an evaluation of synchronous and asynchronous telehealth connections to detect marks on pigs was performed. This evaluation compared the ability of veterinarians to visualize various colors and locations of paint marks on pigs either synchronously using smart glasses, asynchronously reviewing 1080p video footage, or asynchronously reviewing 4K video footage. This study showed significant limitations in color transference across all telehealth methods. Further, regardless of method, veterinarians consistently estimated lower prevalence (percentage of pigs marked in a pen) than the true prevalence of the pen.

More evaluation needed

Rigorous evaluation of telehealth techniques may provide veterinarians and regulatory officials with needed information on the capabilities and limitations of current technologies to make informed decisions on best practices and use cases for telehealth.

Understanding how technology can be used to bolster surge capacity of sample collectors in a potential foreign animal disease outbreak may aid in creating response plans to emerging diseases. Further, a comparison of telehealth techniques to in-person (gold standard) veterinary visits can reveal best practices for using telehealth.