Pet-Specific Care for the Veterinary Team. Группа авторов

their pet's wellness care year over year.

       Empathy or compassion discounts: in lieu of general discounting, each veterinary care provider could be given the discretion to provide a discount when they feel a patient care encounter merits one (i.e., job loss, family tragedy, extenuating circumstances, etc.). There should be established limits for the annual (or quarterly) amount a veterinary care provider can extend, and once that limit is reached, there are no empathy or compassion discounts beyond that point. That will rein in the unlimited discounting some practices employ.

TAKE‐AWAYS

       Design written protocols that all staff understand, and the practice owner enforces in allowing discounts.

       Provide a set annual limit for all providers to utilize when circumstances warrant.

       The plan should attempt to capture new patients as well as reinforce good pet owner behavior.

       Rewarding poor pet owner behavior with discounts is generally counterproductive.

       Keep the discounting plan consistent with little change between review periods.

MISCELLANEOUS

      Recommended Reading

      1 Lee, J.G. (2015). Dissecting the discount: are incentives worth cultivating new and loyal clients who may be worth 10 times the original investment? http://veterinarybusiness.dvm360.com/dissecting‐discount

      2 Smith, D.P. (2016). The Daypart Dance. www.qsrmagazine.com/menu‐innovations/daypart‐dance

      3 Stewart, J.K. (2017) Patient discounts – the fine line between leniency and liability. www.medicaleconomics.com/medical‐economics‐blog/patient‐discounts‐fine‐line‐between‐leniency‐and‐liability

2.12 Blockchain in Veterinary Medicine

      

      

BASICS

      2.12.1 Summary

      Blockchain may be a foreign concept to many, but it is an important topic because it is demonstrating real benefits in many aspects of human healthcare and is bound to gain more prominence in veterinary medicine as well.

      Blockchain gained some notoriety with the introduction of Bitcoin and other cryptocurrencies, but it has been recognized as having many more applications, including its use in healthcare. It could be particularly useful in pet‐specific care in which various stakeholders could have secure privileges to various aspects of the medical record.

      2.12.2 Terms Defined

      Blockchain: A database that is shared across a network of computers.

      Hash code: A form of cryptographic security that, unlike encryption, cannot be reversed or decrypted.

MAIN CONCEPTS

      Blockchain just refers to an online database shared across a network of computers, but it differs from other databases in a number of important ways. For security, once a record has been added to the chain by a legitimate entity (such as a veterinary clinic, laboratory, or specialty center), it is very difficult for others to change. For consistency, the network makes frequent checks to ensure that all copies of records are the same across the entire network.

      In a blockchain, individual records are bundled together into blocks, and then linked sequentially within the chain. The three parts of the process are thus:

       the record

       the block

       the chain.

      For any given transaction, the process involves recording the details of the individual transaction (record), including digital signatures for each party. The computers in the network, called nodes, then verify the details of the record to make sure it is valid. Accepted records are then added to a block and then the block of records is ready to be added to the chain. Each block contains a unique code, called a hash, that identifies where it belongs when assembled into a chain. These hash codes are created by a mathematical formula and contribute to the security of the system. In the final step, the blocks are added to the chain, and the hash codes connect the blocks in a specific order.

      Any change to the original record, no matter how miniscule, would be detected and would warrant the generation of a new hash code. That change to the hash code alters the blockchain, making it extremely difficult for hackers to make changes that are not immediately detected within the network. It's not impossible but attempting to change all the hash codes within the chain would require phenomenal computing power, making it much more secure than current systems.

A blockchain database is decentralized and computers in the network are nodes, so there is no master computer in the system. With a decentralized network, all the participating nodes can access the information and compete to be the next to add to the database, so the system sets up tests of trustworthiness. These tests are referred to as consensus mechanisms and require network members to prove themselves before they are allowed to add to the chain.

      To make sure only authorized users have access to the information, blockchain systems use cryptography‐based digital signatures to verify identities. Account holders have private keys that are nearly impossible for hackers to discern, but public keys can be generated for information sharing. In this way, anyone with a public key can receive information (such as a disease registry or insurance company), but only those with a private key can alter that information (such as permitted medical professionals, laboratories, etc.). Third parties, such as pet owners, can be given limited access to records, while the audit trail capability of blockchain means there is complete documentation of the creation, modification, and attempted deletion of records.

      2.12.3 Healthcare Applications

      Current systems for sharing electronic data among doctors, patients, referral hospitals, laboratories, and insurers are still quite error prone. Incorrect information can emerge as patient data are reentered time after time by different individuals and it is difficult to conserve changes made by one party into everyone's version of the medical record. So, for example, if a patient is seen by both a primary care and a specialty clinic, changes made to the medical records at either facility are not immediately captured in the medical records of both facilities, and require multiple steps to send, receive, and enter information; errors and omissions are possible at all stages.

      Blockchain can be used to provide all clients and providers with identical content. The decentralized ledger approach to information management gives all parties simultaneous access to a single record of strongly encrypted data at relatively low cost. It also creates an audit trail each time any data item in the record is changed, helping to maintain the integrity of the system and its information. Eventually, blockchain could be used to provide secure and accurate medical information for all individual patients.

      With