helping veterinarians be faster and better

EchoVet is complex, and we have provided some of the design and implementation rationales, and to answer some questions that come to mind.

 

  • Automatic Data Entry

    Can I populate EchoVet client and patient fields from my current practice management software?

    We are planning on providing this option for users, and it is currently in development.


     

    Can EchoVet populate the report to my current practice management software automatically?

    Currently, we provide both a PDF output and a copy/paste output for entry into your current practice management software

    We have plans to automate this process for all major practice management software


     

    Can EchoVet populate bill items into my current practice management software?

    We have no current plans to implement this, though this might change with user demand.

    Linking billing to the clinical record is tempting, and often done with current practice management software. Having clinicians input charges is not time or cost effective. Having staff input charges generally results in better charge capture.


     

    Will EchoVet automatically populate the data fields from my ultrasound machine?.


     

  • Assessments (for EchoVet 2.0)

    • Over 10,000 assessments (diagnoses) are provided, through a page-by-page review of many of the major textbooks in veterinary medicine.
      • Naming has been carefully chosen.
        • Facilitates web based lookup.
          • ie, Acute Kidney Injury (acute renal failure) instead of Acute Renal Failure (acute kidney injury).
            • Newer naming system and more accurate (the kidney is injured and possibly recoverable).
            • EchoVet’s powerful find system can find acute renal failure just as easily for you.
            • Wikipedia and PubMed search is automatic instead of EchoVet user having to refine their search
        • Is hierarchal so that an Assessment goes from more generic to more specific, just like a clinician thinks.
          • ie, Acute Kidney Injury (acute renal failure) > Acute Kidney Injury (acute renal failure), bacterial pyelonephritis > Acute Kidney Injury (acute renal failure), bacterial pyelonephritis, Borrelia.
            • This is how we would figure a case out. We would first figure out their was acute kidney injury, then that it was due to infection, then which organism is responsible.
            • This allows us to list all the bacteria typically responsible for acute kidney injury.
        • The naming system does not fit SNOMED, for various reasons. We have not done mapping to SNOMED.

  • Design

    • It took a huge amount of time to try to arrange all this not only logically, but in a way that promoted ease of entry, and also not have a “cluttered” look.
    • We wanted to have about anything any veterinarian might want to enter (because we use about all of this in our practice), and not limit it to what we (or someone else) might think is important.
    • It also had to all fit on a laptop or tablet without scrolling. We can only hope it is acceptable.

  • Customization

    Can you make a custom version for me?

    No

    Future versions take into account all the feedback we receive from our customers, and we implement those things that are requested by the most people, figuring those are the most important


  • Finding Options and Assessments Pre-populated

    • We placed complete sets of possibilities so that users could simply start using the system right away with minimal setup
      • (our own theory as to why new systems are so hard to implement for the user, and are rarely set up adequately).
      • They are all user changeable so users can use whatever they want to put in instead.
  • Measurements

    • Arranged left to right, more often used to less often used, less complex exam to a more complete exam.
    • User selectable normals. It is confusing to report that a value is normal but have it show up as outside the range. One can now tailor the normals that are shown.
  • Findings

    • Again, arranged left to right, more often used to less often used, less complex exam to a more complete exam.
  • Charts

    • The most important values to follow over time, without being overwhelming and useless
  • Recheck Trends

    • Both primary assessments and recheck trends. Most of us charge less for a recheck than the initial exam, but it takes more time to analyze the changes over time from the initial exam. Having charts and recheck trends changes that.
  • Reports

    • Another big hurdle. We only wanted things to show up in the report if they were measured or analyzed and reported on. Nothing is more confusing to a client than having a bunch of empty spaces to explain.
    • Measurements can be placed according to user preferences, before or after findings.
      • They are accessible if needed, and charting is more useful for trends for most cases.
  • Units of Measurements

    • M-Mode and TwoD
      • Units are in centimeters
      • Many modern ultrasound machines use centimeters, as do newer reference values. This saves time transposing from centimeters to millimeters.
    • Spectral Doppler
      • Units are in meters/second
      • Again, many modern ultrasound machines use meter/second, as do newer reference values. This saves time transposing.
    • Tissue Doppler
      • Units are in centimeters/second
      • While ultrasound machine manufacturers appear to be divided on whether to use meters/second or centimeters/second, many reference papers are in centimeters/second.
      • Also, wall velocities are much less than blood velocities, and this made sense to us.
  • Nomenclature

      • This will be the most controversial part of this project. There is no nomenclature committee in the veterinary cardiology community (though we would love to a part of this committee if formed). We elected to ask forgiveness rather than permission, in order to get this project finished within a reasonable timeframe. We also designed the database so we could change the designations if deemed highly objectionable in the future.
      • We placed a “mouse-over” feature (not available on tablets since you cannot “hover”) over every abbreviation used so that each abbreviation is defined (ie, “mouse-over” LVIDs shows this is Left Ventricular Internal Dimension at systole.
    • M-Mode
      • These have been in use for decades, and are mostly acceptable. LVIDs vs LVEDD is a minor user preference that I did not program in until I see overall use of the program.
    • TwoD
      • The left atrial dimension, area and circumference abbreviations are not agreed upon, though we used those that have been used in the literature
    • Spectral Doppler
      • Most of these are well accepted. Use of MPI or RMPI vs LIMP and RIMP will make for a spirited and entertaining discussion (who wants their left ventricle to be LIMP?)
    • Tissue Doppler
      • There is no universal consensus in the human literature, much less the veterinary literature. We looked at this extensively. We elected to use a human consensus statement that recommended e’ instead of Ea, since Ea stands for arterial elastance in physiology.
    • Segmental Wall
      • This has been labeled the “tower of Babel” in the human literature, and has not been addressed at all in veterinary medicine, from what we could find. This is an important part of our evaluative process, and communicating these findings seems important. We used the system that seemed most useful and user friendly to me. Since this has the most possibility of ruffling feathers, I made all of these user changeable, but limited the changes (due to the graphics) to a 16 segment system (we will probably never need to correlate to coronary artery segmental flow abnormalities).
  • Normal Values

    • We have performed an extensive search over all the veterinary literature to place as many normal reference values as possible.
    • Since this list is so extensive in some cases, and then non-existent in others, We then designed a way for you to choose which references you choose to use.
    • We have placed very few reference values in that were from anesthetized animals, since clinically, we work on awake animals. In a few special cases, we have deviated from this policy, especially where invasive measurements from echocardiographic parameters were obtained.
    • If the references were limited to less than four, we placed all of them in for you.
    • We used mean and standard deviation normals first, and then ranges after that, since they are so much “wider” than mean and standard deviations.
    • Some values are placed in multiple places, where you can obtain these values from multiple examination parameters (Spectral Doppler MPI is a good example)
    • Users cannot place their own normal values in the system, since all these values are part of the code, which is part of why this such fast system with so many values. As use and demand of the system dictates in the future, we will be able to add user-specific normals for all to view and use.
    • Only endocardial values of Tissue Doppler measurements have been used, since these appear to be what are evolving to be most clinically useful.
    • Some papers, after careful perusal, have apparent errors that make them either difficult or impossible to use the values from. We have not placed these in the system.
    • Others have apparent errors in decimal points for one specific value. We have placed these in the system and marked them with an *
    • Others provided a mean value, but no standard deviation or range. We have noted this.
  • Breed Designations

    • We have provided virtually complete lists of breeds (who would have known there were so many!) for users to select from.
    • This is because the programming of the system to have breed specific values depends on accuracy of matching the breeds precisely.
    • This means you might have to search for an Irish Wolfhound instead of a Wolfhound, because according to officials that set breed names, the real name is an Irish Wolfhound.
    • If you manage to circumvent the system and place a breed that is not in the system, you will not get any breed normals.
    • Just by placing a breed in, you get the breed normals, if they exist and we have placed them in the system.
    • Domestic Short Hair cats are a current dilemma as to whether to categorize them as a generic feline or special breed. We might do them as both in the future.
  • Other Species

    • We have programmed and placed reference values in for Canine, Feline, and Equine.
    • These are the most common species examined in veterinary medicine. We placed Equine in for the academicians, though the number of cases that will be performed will be much less than the other two species.
    • We have also programmed in Human, though this cannot be utilized in EchoVet and is not accessible since we have not researched all the HIPPA requirements. We think this mode of analysis and the great flexibility that is built into EchoVet might be useful to the human field.
    • We have no plans to program in other species, though we could be induced to change our minds if EchoVet is well adopted.