Dr. Christie Long on How Technology Can Improve Veterinary Medicine | VETGirl

"Our veterinary team is practicing every day to deliver excellent medical care, so it's critical that the software we build serves their needs," said Dr. Christie Long, VP of Medicine at Modern Animal, on this month’s episode of VETGirl’s Veterinary Continuing Education Podcast. For Dr. Long, the COVID-19 pandemic was a wake-up call for the veterinary industry, highlighting the need for more efficient and effective ways to provide quality care.

In human healthcare, it’s relatively common to see apps, easy access to medical records, and sophisticated practice management systems. Unfortunately, in the veterinary industry, many veterinary professionals are still grappling with poorly-designed software solutions, which lead to wasted time and lost productivity. To avoid the problems we observed with off-the-shelf software solutions–crashes, bugs, inflexible workflows, and so on–Modern Animal built our technology platform, Claude, from scratch. Claude is an ongoing project that brings members of our engineering, product, and in-clinic teams together to collaboratively build the tools that empower our practitioners to sustainably deliver personalized care.

“I did not decide to become a veterinarian because I loved to write SOAPs. We all know the importance of it, and we all know how key it is to patient care, but technology can help you create a better medical record. For us, that came down to owning our software ourselves and not buying something off-the-shelf.”

Improving the veterinary experience starts with empowering veterinarians to focus more on providing excellent care and less on paperwork. This means building systems that are designed with the veterinary team in mind, making it easier for them to maintain concise and complete medical records that can be easily accessed by other veterinarians or specialists. It also means providing pet owners with quick access to care, reliable communication with their care providers, and easy access to pet records, diagnostic results, and prescription refills through our Modern Animal app.

In this episode of VETGirl, Dr. Christie Long talks with Dr. Justine Lee about the need for continued innovation in the field of veterinary medicine, how telemedicine has emerged as a critical tool for human healthcare, and why Modern Animal chose to build our own technology in-house, rather than off the shelf. Topics include:

• The role of technology in improving the quality of care
• The barriers to telemedicine post COVID-19
• The need for continuing innovation in the field of veterinary medicine
• How Modern Animal is transforming the pet owner experience, and enhancing quality of life for veterinary professionals

Full Interview With Dr. Christie Long on VETGirl Veterinary Continuing Education Podcast

To watch the full episode, head on over to VETGirl or listen now on Apple Podcasts.

Dr. Justine Lee:

Hi! VETgirl here, and today, I’m super honored to be speaking with Dr. Christie Long from Modern Animal. Dr. Long, thank you so much for joining us today.

Dr. Christie Long:

Thank you. It's great to be here. Dr. Lee, really a big fan of the podcast and everything VETgirl, so thanks.

     
Dr. Lee:

Awesome. So, to help our audience know a little bit more about you. Who are you? Where did you train? Where'd you go to vet school, and what do you do now?

Dr. Long:

Well, at the heart of it all, I'm a small animal veterinarian. I trained at Colorado State University. Obviously, I'm not unbiased, but I do believe it's the best veterinary university out there. I graduated in 2004 and I practiced small animal medicine in Fort Collins, which is where CSU is located. I really enjoyed the practice of small animal medicine. I moved on from there and went to work with one of the very first veterinary telehealth companies, a company called Pet Coach.

We offered online consulting and online question answering to pet parents all around the world–everything from pigeons to cows to dogs and cats. Of course, we ended up selling that business to Petco in 2017, and I moved to San Diego here on the beautiful coast of America in California, and I got to work in Petco for a couple of years building a couple of interesting concept stores, which had a membership kind of model around them, veterinary care and daycare and grooming, and things like that.

So, that was sort of my first exposure to the retail side of things and also to the idea of a membership model encompassing veterinary care. I ended up joining Modern Animal in 2019. I heard about this guy, Steve Eidelman, who was starting a company that was going to really leverage technology and a better experience not only for pet owners, but for veterinarians and veterinary staff members. And I was fascinated and wanted to be a part of it. And then I guess one more note, prior to all of that, I was a software engineer before I went to vet school, so I really love that my current role sort of integrates those two halves of my career.

Dr. Lee:

That is so awesome. Obviously we love technology here on the VETgirl side, and it is so interesting. I always joke in the veterinary space, most veterinary professionals do not embrace technology. I mean, we're still advertising and still sending out faxes and using fax machines, so I absolutely love the fact that you're integrating your background and technology with your expertise in veterinary medicine. Now, I did want to ask a couple of questions. When it comes to telemedicine and technology, I know we're still two years out post Covid. Do you think veterinary medicine has had problems with delivering care?

Dr. Long:

I think so. I think we kind of got knocked back on our heels during Covid, right? I think for about two weeks we wondered if we were going into a massive recession and if nobody was going to be able to afford to take care of their pets. And then of course the opposite happened and not only did everybody sit at home and start staring at their pet, and wondering what was wrong with it, they went out and bought and got more pets, adopted more pets, or decided they were going to get their first puppy. So it took us a while and obviously it came at a great cost. A lot of people experienced burnout during Covid with huge patient loads. Of course, your side of the fence, and ER medicine and critical care, those facilities were just swamped. So I think we're struggling a little bit to adapt post Covid.

I think that we talked a lot about technology, especially as it relates to telemedicine during the pandemic, and a lot of practices tried it. I think the part that was missing was the integration, but not only the workflows and just the way that practices run and do things, but also the technology itself–the platform. And so telemedicine kind of felt like this strange appendage to a lot of veterinary practices because of that. And so it was one of those things that maybe fell by the wayside after Covid. And then here in California, we actually saw a relaxing of the regulatory environment around providing telemedicine. And we're hopeful that the veterinary medical board was going to stay that way after the pandemic, but they actually, sort of went back the opposite way. And I think some states, like Texas, also adopted a similar stance. So I don't really think that the idea of providing care in a virtual environment when it makes sense for the patient really advanced after Covid. So I think part of it is a regulatory piece to that. But there's also just the technology, in general, wasn't quite there. And I think we're still trying to figure that out.

Dr. Lee:

I couldn't agree more. Covid was really interesting. I think it really taught us perspective on how family, our loved ones, are most important. It taught us that some people can't work remotely. It taught us the importance of essential workers and veterinarians not being the most likely to embrace technology. It opened up opportunities like telemedicine, which was amazing and we'll talk about that in a little bit. I will say you're right from the ER perspective, it was hard because we went from a two to five hour wait, which still sounds insane, to a five to 12 hour wait routinely. And I remember in the first couple of months having owners come in waiting for hours, and at that time they were still in their car in the parking lot saying, “I have this puppy, he has worms. I can't get into my vet for two months. I'm okay paying hundreds of dollars for the ER fee.” And so it really blew my mind. It was really hard because I had so many neighbors who had a hard time getting their younger pets for routine procedures like spays and neuters. So I definitely feel like we did have problems with delivering care. Now that said, what can we do now? Obviously it's easier with our 2020 spectacles on, but what can we do to make pet owners feel like they can't access care more readily?

Dr. Long:

I mean, there's so many things. I think that working with our regulatory officials, our state veterinary medical boards with our veterinary colleges, to really start to think about how we intelligently apply telemedicine to veterinary medicine. I don't know if you've used telemedicine yourself personally, but the rules in human medicine, I mean, it's a different ballgame. You can actually get a prescription without even really meeting with a practitioner in any sense. And so I think that's part of it. I think there are ways to provide access to care that don't necessarily mean having a veterinarian sitting there and diagnosing and prescribing in a virtual world, although that is definitely a valid application for us. It became a lot about providing that 24 hour support from licensed veterinary technicians. Here's a segment of our workforce that wants to continue to be viable and vibrant and offer the skills that they've gained.

It's a physical job. A lot of them just physically can't do the work anymore. And then of course, throw Covid on top of that. And people didn't want to work outside their homes, but they still have a lot to give. And clients need that support. I mean, I always joke that one of the questions I remember one of our members coming to us during the pandemic was, “I just washed my puppy and I don't know, can you help me figure out how to dry him?” And so, you know, you can't ever underestimate the kinds of things people need help with. So being able to provide that level of support and also helping people figure out when they really need to come in. And I think that is such a huge part too, really making the visit valuable from the standpoint of the client, from the standpoint of the doctor's time, making sure that what they're seeing in front of them is a truly good use of their time and there's not someone else or another patient that could have benefited more from that. I think that's how we can increase access to care and it doesn't necessarily have to be in the physical space.

Dr. Lee:

Agreed. I will say I didn't learn to embrace telemedicine until I had my own kid. And in the first year or two, they had so much disgusting disease from daycare, and I just wanted to do telemedicine, and be like, “Look at this rash or look at his pink eye. Can I just get a script?” So it is really interesting, and obviously we talked about technology, but some veterinary professionals don't embrace it quite as readily. Now I know with your background with what Modern Animal’s approach to technology is, do you mind just talking about that a little bit more? How does the technology built by Modern Animal enhance the capabilities of veterinarians to improve the overall care for pets?

Dr. Long:

Well, I mean, I referred earlier to the idea of integration. And I guess I would say the veterinarians that I know and have worked with aren't necessarily Luddites. Not that people hate technology, and by the way, we can also blame the pharmacy industry for some of this–they continue to use the fax machine more than any segment of our industry, I think, more than any other. But I think that veterinarians would embrace technology, but they don't necessarily really have time to figure it out. I mean, maybe you have someone in your family who knows how to make computer systems work together, or maybe you even have a budget for that. I think some of the consolidators that are in veterinary medicine tend to just acquire the practice and not necessarily upgrade the technology. So for us, we have an in-house engineering and product design team.

It was really a matter of looking at the problem from the ground up. Let's think about what this looks like if we design it, as opposed to buying. Let's build the technology so that it really serves the needs of not only our clients who want access to care, who want to pull out their phone and have an app that they can communicate with their veterinary team with, and ask for a prescription refill, or download their pet's records, or look at diagnostic results. But more importantly, to make it so that the veterinarian can write medical records that are succinct and cohesive and makes sense for the next veterinarian who comes along, or a specialist, or whoever has to have those records to go home on time. How about that for an idea? I mean, I did not start deciding to become a veterinarian because I loved to write SOAPs.

We all know the importance of it, and we all know how key it is to patient care, but technology can help you, and it can help you create a better medical record. And so for us, that really came down to just owning it ourselves and not buying something outside or off-the-shelf because we really wanted to be able to say, “Hey, this is not working the way we need it to work. This is creating a bottleneck in our workflows. What can we do? How can we change our technology to make that work?” And then go do it.

We call it Claude Council because our practice management system is called Claude. I don't know if you were aware that a veterinarian named Claude in the 16th century in France started the first vet school. So we have a Claude Council that is composed of individuals from across our practices who, on a weekly basis, give feedback to our product team about what is and what isn't working with our software. And so for us, it's just really about, and I would say this was a lesson we learned along the way: the software has to serve the team. Our team is our customer, and our team's attempting to practice every day, and to deliver excellent quality medical care.

Dr. Lee:

Oh man, I could talk to you about this forever. I was just complaining to fellow criticalist how unfortunately what's happened, and one of the reasons why I got so burnt out during Covid, was you would spend 20% of your time examining critically ill, and 80% of the time doing EMRs electronic medical records, where it should be the opposite. And I remember saying to several high-ups in the hospital saying, “Why are we doing shift summaries? Why are we SOAPing this patient and documenting it three times a day compared to what we did 20 years ago?” Obviously it needed to improve. We needed to document more, but now some of these medical records for a two day visit are 40 pages long. And it should be reversed. It should be us putting our hands on the patient to improve quality of care versus just cutting and pasting the history from before. History needs to be once a day. It doesn't need to be cutting and pasting.

Dr. Long:

Right, right. They're still in the hospital.

Dr. Lee:

Exactly. So it is really interesting. Unfortunately, I do feel like generationally we've developed, we've realized there's so much technology, we often type really fast, but at the same time it can potentially impact our quality of care. So I love that you guys created your own technology in that area. So you talked about how Modern Animal can enhance quality of life and capabilities for veterinarians, veterinary professionals. What about for the pet owner specifically and for the pet?

Dr. Long:

I mean, if I think about our two customers at Modern Animal, and I just talked about our team being our customer, and also obviously we have the people with the pets who come in the door to help their pets live longer and happier lives. I think if you look at veterinary medicine and what we set out to solve, and what we are still solving, is the pain points on both sides. It turns out that it was probably an easier proposition to modify in a meaningful way the experience that the client has in the practice. Because let's face it (and please anyone who listens to this and has taken great pains to build a beautiful practice that's comfortable for all involved, you're not who I'm talking to), but in veterinary medicine, we haven't really paid attention to the physical space. And so it turns out that whatever you can do to make it more comfortable for the client, you also can do the same for your team.

Noise reduction, natural lighting, taking the phones out of the practice so that they're not constantly ringing, and constantly making that chirping noise the phone makes when somebody's been on hold too long. Talk about setting your nerves on edge and making it really difficult to concentrate. But all those things are important. Giving someone a LaCroix or a cold brew when they come in with their pet because when somebody's comfortable and feels good in a space, you are probably going to be able to have a really good conversation with them about a proposed diagnostic and treatment plan for their patient, that they may be, and I don't have any double-blinded studies on this to prove this, but my suspicion is that they may be more amenable to doing what needs to be done if they feel comfortable in the space. And so for us, that translated into a lot of glass, and a lot of transparency in our practice.

We have an open practice. People are welcome to come into the treatment room anytime they want to be with their pet before and after surgery or before and after dentistry. It builds trust, it creates an environment where people see what we're doing and they gain respect for our team's skills and they know what the money went to. So I think for our clients, it's just improving access in all areas, whether it's virtual or in the physical space that has really resulted in a better experience for them. And one of the reasons why if you go on Google or Yelp, you'll see a lot of really positive things about Modern Animal.

Dr. Lee:

That's great. I always say transparency is so important. All right, we talked a little bit about telemedicine. Do you think this will change now that Covid is over? And I know there's some recent changes with VCPR. Can you discuss the role of telemedicine in Modern Animal’s service offering and how it has impacted the way that veterinarians interact with their patients?

Dr. Long:

Yeah, absolutely. As I've said, we live in pretty much the most stringent state with respect to what the VCPR is and how it can be captured. And I remember back in 2014 when people were saying those letters, and I was having to remember, I learned this in vet school, but it's not something I've thought about since then. But I tell you, people have, when veterinarians have practiced telemedicine since the advent of the phone, people call and we make changes to medication based on what they're telling us, or we might write an additional script. The ability to easily do video calling was not the advent of telemedicine in my mind, but some states have looked at it as a competitive threat, I think, or potentially having an impact on quality of care. If you look to our neighbors to the north, which you're way closer than I am to those guys up in Canada, Ontario has had the ability to capture the VCPR electronically for many years, and they've had literally no board complaints related to that. So they really put it in the hands of the better.

Dr. Lee:

Although Canadians are much nicer.

Dr. Long:

That is such a true possible confounding fact in all of this. You're right. I think that what they've done is put it in the hands of the veterinarian, and at the end of the day, nobody wants to lose their license or hurt a pet. So they've had really great success with that. For us at Modern Animal, and because we live in California, we are able to do telemedicine as long as we are talking about a problem that was previously diagnosed or discussed in the physical setting. So for us, telemedicine is not someone chatting in to say, “I think my puppy is car sick. Can I get something for that?” The answer is that they have to come in because we have not talked about that problem in the physical setting. And you and I could talk about whether that makes sense or not, but at the end of the day, the law does not allow us to do that.

So our veterinarians who are providing virtual or tele-visits are doing so based on preexisting problems. So a lot of a monitoring of chronic diseases, renal failure, cats, diabetic dogs, behavior issues that we can continue to check in on the patient at home, and we can actually really make a lot of difference and see their progress in that setting, which by the way, behavior issues are compounded in veterinary facilities, so it just makes sense to do that. The other thing that we really rely heavily on our doctors when they are in our telemedicine setting is to follow up on lab results when they come in on days that the original submitting veterinarian was not in. So again, nothing new or groundbreaking, but just making sure that you don't come back from your seven day vacation to a stack of lab work. And I know there's a lot of really fun surprises in there that should have treatment, should have already been started. We want to make sure that we tackle that as soon as we're able to when it makes sense. And then finally, they serve as the backstop for our frontline on virtual care when questions come up that they can't solve or they don't know the answer to the virtual veterinarians there to help them with that.

Dr. Lee:

Wonderful, thank you so much. Now, I know we're all still super busy and it's crazy right now. Who knows when this is going to stop, but in the busyness of veterinary life post-Covid, how can we support exemplary medical quality?

Dr. Long:

Such a good question and such a huge area of importance for us at Modern Animal. I think it comes back to culture, and when my boss, Steve Eidelman founded Modern Animal, he really believed that practices needed to be started from the ground up, and culture was a reason for that. So creating the kind of culture that you want. So as that relates to medical errors, I think it's really important to create a culture where we don't look to blame someone when something goes wrong. And this, I'm sure you talk to anybody who is involved in medical quality on the human side, you have to create a culture that it's okay to report making a mistake. And it's probably even better to report almost making a mistake because the emphasis has to be on, there's something in our system that is causing this.

Either the individual's not trained properly, medications aren't stored properly, our software is not supporting us, whatever it is, we want to get to the root of the problem and solve it and then make changes so that it doesn't happen again. So the first step to that is a culture where people say, “I did this and I want to be better and I want to get better at doing it.” So for us, that's involved creating a platform so that our team can easily go in and report adverse events as we call them. And I think it's a pretty widely recognized term when something goes wrong. And then we monitor those, look for trends across the practices, publicize them to other practices, so other practices and say, okay, wow, this happened in Pasadena. Let's make sure it doesn't happen in Studio City. So that's how we've tackled it. There's been a really big emphasis on the culture we're building.

Dr. Lee:

That's great. I always say learn buyer mistakes. The biggest thing I learned from a mentor is never to make that mistake again. And mistakes happen as people get busier or if it's an environment where people feel intimidated about asking and saying, “Is this the right amount of Mannitol? 60 ml sounds like a lot, and it is a lot, right?” So when in doubt, having that psychological safety in the workplace to be able to ask those questions, is really, really important.

All right. We always hear about, in full disclosure, I'm Gen X, but we always hear about today's pet owners like millennials and Gen Z. How are they different? Do they embrace technology more or do they prefer a membership-based approach to access their veterinarian? And what do you guys do at Modern Animal that you find is successful in terms of approach and how it potentially benefits us as clinicians?

Dr. Long:

I mean, the answer is all of the above. And the pandemic only accelerated that outside of the millennial generation. I mean, people my mom's age are now downloading apps onto their smartphone and using them. We went through a period where nobody wanted to touch each other. I think we're finally getting out of that. And as a dedicated hugger, I'm pretty excited about that. But I think we actually opened our first hospital in August of 2020, which was essentially the second week of the lockdown. And people were starting to talk about what the curbside looked like. And for us already having an app that allowed video calling, we were able to set up a camera set up in the exam room so that people could see the doctor while they were sitting in the lot. So add to that, a whole bunch of people with new pets who had never been pet owners before, add to that people with a ton of questions, a new practice that nobody had ever seen before, and they were expected to just hand their pet over to this person wearing a disposable gown and full hazmat gear while it disappeared inside the building.

And that went a long way towards building trust. And so again, I can't emphasize it enough. I know I've talked a lot about it, but also the ability for people to, once they leave, get the questions answered that they always think about once they get home, they forgot to mention and without having to call the practice and wait while someone answers their question. So I mean, look, millennials are quick to adapt technology and expect technology to be there for them. They're also postponing childbearing. So for them, their pets are their children. For many of us, we have both kinds of children, like me and probably you. I think that they needed that support, and no question was too elementary for us to answer in that environment. And that just built a whole, whole lot of trust in a time when it was really hard to come by.

Dr. Lee:

I agree. We're going to see the downstream effects of Covid for a long time. And I always say I'm optimistic by nature. I would say obviously there were a lot of negative things that happened, but for once, veterinarians, veterinary professionals, we can't complain about revenue because we're obviously very busy. But I do think we do need to embrace technology just to make sure that our clients still feel like they have access to us because life is crazy, life is busy. And again, when in doubt, try to embrace that technology. Dr. Christie Long, thank you so much for what you do. Absolutely love it and really appreciate you coming on today's VETGirl podcast.

Dr. Long:

Thank you, Justine. I've really enjoyed it and I appreciate everything that you've created at VETGirl. It's made a big difference for me personally and lots of folks I know. So thank you.

Dr. Lee:

Thank you so much. Take care.