I've been an equine vet for 16 years. The software was never built for ambulatory work

I've been an equine vet for 16 years and in that time there have been very few advances in the practice management software (PIMS) available to vets. That is fairly surprising considering how much technology has evolved in that period. Equine vets are largely still using systems built decades ago for small animal practice, and while there are one or two workable options, none of them come close to solving the real pain points of ambulatory equine work.

The diary management problem

One of the most significant pain points for both vets and practice leaders is the inefficiency of diary management. The inevitable emergencies play an unavoidable part in this, but other problems are compounded by technology gaps. When a client calls needing a visit, it's very difficult on current systems for the office team to see which vets are in the area close to that client in the upcoming days. The office team have to hover the mouse or click on individual appointments in the diary to get addresses, relying on personal knowledge of local geography, and then either opening a separate route planner or making an educated guess about drive times. It is a manual, time-consuming process, and in a busy practice with stressed clients wanting a vet, it means appointments are often booked on the basis of availability rather than efficiency. Vets end up with fragmented days with lots of driving; mileage costs increase and, more importantly, frustration builds among the vets.

Most vets head straight out to visits, but some may have the chance to go to the clinic first, where they can log on to the PIMS to scan through the diary or look up histories, and catch up on admin including writing clinical notes and booking from the previous days. Once they leave the building, few have access to the PIMS on their phone or tablet; most PIMS don't have an app at all, and the ones that do have limited functionality, poor user interfaces, no offline capabilities, and are slow and "clicky".

Therefore, most vets can't see a live diary on the road, and there are two common workarounds: sending out planned visits to each vet the evening before, or the use of generic tools such as Google or Outlook calendars. There are no clinical histories, previous images, or reports, unless they are sent separately. The consequence of not having mobile access to a PIMS is that vets are seeing horses from memory and inevitably, human errors occur. Having immediate access to a horse's clinical history, previous imaging, lab results, and reports should not be a luxury; it is a basic requirement for providing a good level of service to our clients.

Clinical notes and inventory management

Vets know the importance of contemporaneous clinical notes and that the best time to write these is immediately after appointments. However, almost nobody does it consistently in ambulatory practice. Generally, vets are running late because days are busy and the inevitable inefficiencies of equine practice necessitate a packed diary. Additionally, there are the "while you're here"s, emergencies, and traffic, meaning the usual mentality is to get straight on to your next visit.

Even those with the benefit of mobile PIMS access generally don't write their notes or do the booking at the time because it takes too long with the current options. At best, brief notes are scribbled or an email drafted, to be written up at the end of the day, or more often, sometime later that week. The consequences are predictable: critical clinical data is forgotten, drug doses are misremembered, and dispensed medications go uncharged.

The use of AI scribes is becoming increasingly common, which helps save time for the vets, but there are security concerns and it doesn't solve the issue of missing billing of procedures and stock leakage. Additionally, AI scribes are generally separate systems that do not integrate with the PIMS and therefore, as with emails or paper clinic notes, still need to be copied on to the PIMS by the office team, creating unnecessary administrative burden and potentially introducing error.

Stock leakage caused by missed bookings and incorrect or absent movement of stock is a major concern and economic loss for equine practices. Manual and retrospective stock movement relies on vets remembering or having the time to record when they have taken stock, and errors frequently occur. No existing technology has solved this problem, even though inventory management systems in other industries are highly accurate, intuitive, and scalable.

Communication

The inability of current systems to send communication and messages directly to clients means vets message clients directly from their phones, causing a significant pain point and frustration for equine vets. The direct line of communication is abused by some clients with a barrage of messages and videos day and night, and once clients have a personal number, it's very hard to take back. Additionally, there are potential issues with litigation as communications sent on WhatsApp aren't always given the same degree of scrutiny by vets before sending as other client communications, and messages aren't captured in the clinical record.

The solution

While many of these pain points are not entirely solvable, I strongly believe technology can help. Clinical notes will improve, diaries can become more efficient, reduced stock leakage and missed billing will result in increased profitability, and time saved by reducing admin will be beneficial to vets and office teams. In part two, I'll look at how Lupa is attempting to address some of these challenges.