Åbo Akademi University, Finland

INTRODUCTION

Currently veterinarians work on unnecessary and often repeated routine paperwork, that is time consuming and not part of the core business, i.e. helping patients. At horse clinics information can naturally be inserted and stored in a computer, but this cannot be done as easily when the veterinarian is on a “house call” i.e. visiting a stable. Paper work can get misplaced or illegible because of the non-sanitary environments. In the worst cases, the information has to be input several times into various programs, such as the veterinarian’s own practice software, database and billing software. Yet after all this work, if the owner decides to use another veterinarian to treat their horse the next time, all the same work has to be done again and the previous veterinarian’s findings can be difficult to acquire. All of this extra work takes time and money, not only for veterinarians, but also for other stakeholders within the equestrian world.

The problems have been noted for some time and even Fédération Équestre International (FEI), the international body governing equestrian sport, is trying to find a logical, long term solution how to store and verify a competing horse’s medical information. In Denmark a recent study also discussed the potential of a medical database for horses (Hartig, Houe, & Andersen, 2013). Horse identification is also somewhat lagging behind from e.g. bovine animals. Many countries have a database where all bovine animals are registered and can be traced with the help of their ear tags (Trevarthen, 2007; Trevarthen & Michael, 2008). In the European Union since July 2009 all member states have to identify new equidae (horses amongst other) with a microchip or a branding + dna sample (European Commission, 2008). With a reliable medical history, and proper identification methods, a competition horse’s travel between countries could be made easier. One of the first problems to get tackled in a horse’s medical information is to get a uniform vaccination database for all competing horses. Vaccination regulations for competing horses are not only a problematic area for veterinarians but also for horse owners, riders, competition organizers and state officials.

Within the small animal practice industry the competition is growingly larger, and therefore not only the quality of treatment matters but also good customer service when potential clients choose the clinic they are going to use. Within the equine practice, the same trend is likely to occur in the future. Digitalization of healthcare, whether it is for production animals, pets or humans seem to be today’s trend. With horses the problem is that a horse can have several uses; production animal, companion animal and athlete. Depending on which category a horse falls under, it will have significantly different medical needs and requirements. One of the problems to implement a medical database for horses’ which is connected to an IT and mobile service is the adoption willingness of veterinarians and other stakeholders around the horses. Security and privacy will naturally play an important role in the development of such a system, as in human healthcare (Weitzman, Kaci, & Mandl, 2010). Some of the problems introduced in this paper have been tackled and researched within human healthcare digitalization (Hoffman & Podurski, 2008).

M-equine is a system that will be built to support stakeholder’s daily routines around horses. It is to be a web-based support system for veterinarians, with both a mobile and web- interface. In time this will include medical, vaccination, stable and competition information as well as other relevant data of the horse. Depending on the user’s “access level” he/she would only see parts of the information, i.e. a veterinarian with permission from the horse’s owner can read and write treatment information into the system, whereas an outsider would not be allowed to read this information. The specific focus of this paper will be on the m-equine system’s solution for equine veterinarians using mobile devices. For this research it was not necessary to make a difference between mobile phones and various tablet solutions, but all are presented as mobile devices. Within the mobile devices the only distinction done is the difference between basic phones and smart phones. Here within the smartphone category all phones with internet availability are included, thus also phones that could be categorized as “feature phones”. The mobile technology and IT requirements have been established with the help of veterinarians and other stakeholders within the equestrian sports.

Since the goal is to build a system that supports veterinarian work with the help of web- and mobile interface, the question is; how to build a web-based system, that has the potential to expand and support the daily routines of veterinarians? A large obstacle to overcome is the veterinarians’ possible reluctance to use new technical innovations. The system however would give benefits to the equestrian sports, the veterinarian profession in general and for other stakeholders around horses. Furthermore, the m-equine system could serve as a model for other applications and research fields.

The paper is structured as follows. The research domain is introduced, followed by a brief state-of-the-art summary of the current mobile solutions within health industry as well as IT solutions in the meat and milk industry. Thereafter the methodology for this research will be discussed. The design and building processes of the mobile service including the systems conceptualization and design follows thereafter. The paper is concluded with a discussion of the design and upcoming testing of the service with stakeholders.

RESEARCH DOMAIN

Every county in Finland has to provide a veterinarian on call at all times, to care for local animal needs including production animals, horses, cats, dogs and even more exotic pets. The county appoints the county veterinarians in accordance to the Finnish Law of Medical Services for Animals 16 § (Ministry of Agriculture and Forestry, 2009). There are approx. 2,100 licensed veterinarians in Finland, 30% work as county veterinarians and others mostly work at private practices or clinics (Ammattina eläinlääkäri (veterinary as an occupation).2011).

Equine medicine veterinarians specialize in treating hoofed animals, which in Finland is primarily horses. The veterinarians treat and/or inspect all kind of horses: leisure, harness sport, equestrian sport and horses going to slaughter. According to Suomen Hippos (the Finnish Trotting and Breeding Association), there were approx. 73 000 horses in Finland in 2010 (Soini, 2010). Horses must have a national passport and unique life number when traveling since this is the official identification method at racetracks, equestrian competitions and border control (Skarra, 2009) and (European Commission, 2008). Today, horses are increasingly seen as companion animals and used as sport animals; therefore equine medicine, and particularly treatment methods have been developed further than e.g. production animal medicine. Production animals are seldom treated to the extent as horses, since their worth is more likely to be attached to the production value of e.g. milk and meat or to the breeding value of the animal. A horse’s value is connected e.g. to the horse’s age, breed, training level, quality as an athlete but also to its value as meat.

According to EU regulations and Finnish food legislation, all animals slaughtered in EU for human consumption need to have proof of identity and a logbook stating what medications and feed the animal has received during its lifetime (Maa- ja metsätalousministeriö, 1.1.2012). Some medications that are used for horses are considered dangerous for humans. If the horse has been treated with these medicines during its lifetime, the meat cannot be used for human food consumption. Since horses can be sold many times during their lifespan, the medical history that, in most cases, is in paper format does not necessarily move along with the horse. Veterinarians today usually have their own patients’ records on file and according to Finnish laws are required to do so for a minimum of three years, (Ministry of Agriculture and Forestry, 14.4.2000). In 2009 there were 25 equine medicine veterinarians in Finland (Venäläinen, 2009). The problem tough is to find all the medical information of a horse. Apart from equine veterinarians, county veterinarians (over 600 county veterinarians, during 2009) might also have treated the horse and if the horse had been imported from another country, it is virtually impossible to be 100% sure that all medical data is intact (Ammattina eläinlääkäri (veterinary as an occupation).2011).

For Equine disciplines, according to FEI rules, a horse has to be vaccinated against horse influenza and in some countries also against other diseases. This information has to be marked on the horse’s international passport, if the rider/driver wishes to compete with the horse in international competitions (Article 137) (Fédération Equestre Internationale (FEI), 2013a). In Finland at district and national level equestrian competitions, the horse’s vaccination rules differ a bit form the international ones (Suomen Ratsastajainliitto ry (The Equestrian federation of Finland), 2012). Vaccination information is checked from the passport at every competition, and this takes much time. Suomen Hippos has launched a vaccination database, mainly for harness racing horses, but there is no underlying program to support the database, and therefore the only difference is that instead of checking the vaccination information from the horse’s passport it has to be checked from the database.

In 2010, FEI (Fédération Equestre Internationale) started the “clean sport” program against anti-doping, which requires that horses competing internationally must have a medical logbook (currently paper based) that includes the horse’s medical history, article 1026, 3§ (Fédération Equestre Internationale (FEI), 2013b). The logbook includes information on what and when the horse has received medication. E.g. some horses have to be mildly tranquilized for shoeing. If trace elements of this tranquilizer remain in the horse’s blood, beyond the pharmaceutical company’s safe date, then a positive doping test may result.

The m-equine system would be developed to support a veterinarian’s daily routines. The web-based system with both a web and mobile interface would help solving some of the main problems that have been identified within the research domain. Standardized electronic identification of horses, combined with an underlying medical database would ease the identification of the animal and its medical care. Different stakeholders need different information, and not all of these stakeholders know horses. The information a border control officer needs is vastly different from what e.g. FEI’s doping control, veterinary examination or pre-slaughter examination needs. The m-equine system would allow different users to access different information, so that the information is relevant and useful for the user in hand.

RELATED RESEARCH

In recent literature, the digitalization of human healthcare has been much discussed (Boulos, Wheeler, Tavares, & Jones, 2011; Hansen, Gurney, Morgan, & Barraclough, 2011; Michael & Michael, 2009; Ngai, Poon, Suk, & Ng, 2009). The development of mobile technology has enabled mobile phones to be used not only as personal devices but also as work tools in one’s profession. Already in 2010 there were over 7000 documented cases of mobile phones being used in healthcare (Kailas et. al cited in (Boulos et al., 2011)). The introduction of smart phones has opened up much more possibilities for various applications that the previous mobile devices did not have. In many of the papers mentioned above security and privacy issues have been mentioned as an important factor that should be addressed when dealing with mobile healthcare.

In her 2005 published doctoral thesis, Han discusses the mobile technology usage and adaption among Finnish physicians. In this study, once the physician started to use mobile technology (in these cases the content of the service was basically a Nokia communicator that included the whole Pharma Fennica, i.e. the Finnish medicine encyclopaedia) he/she was positively inclined towards the technology’s usefulness and usage (Han, 2005). This dissertation gives a picture of the physicians’ attitudes towards mobile services, which can, to some extent, be related to veterinarians’ attitudes. For both professions the core business is mostly diagnosing and treating a patient. Any mobile or IT service will therefore have the role of a support tool. One of the large differences between physicians and veterinarians, from the viewpoint of their IT and mobile needs, is that they have very different working environments, especially if the veterinarian is working in the horse stable environment. Even in the not-so-sanitary horse stable environment a mobile device could be used by a veterinarian to enter treatment information, which physicians would not need since they usually work in offices with computers. Therefore, in this paper the research question has been taken a bit further than Han’s dissertation.

In a more recent study, by Choi et al (2011), the research focused on how doctors use smart phones and the “Dr Smart” mobile application. This study was conducted in the end of 2010 and the results showed that younger residents in their 20s and 30s were more likely to use the application. In this research one reason why some doctors did not use the app was because they did not know how to download the app onto their smart phone (Choi et al., 2011). This same kind of problem was also already discovered in Han’s dissertation (2005). A notable amount of physicians never even tried to use the mobile phone and the medicine encyclopaedia within it, since they did not want to try something new, which could possibly be difficult to use and take time to learn to use (Han, 2005). Many of the same problems that were discussed in the “Dr Smart” research by Choi et al (2011) and Han’s (2005) study have to be solved, so that a working mobile service for veterinarians will reach a high penetration rate within the field. Users should be trained to use the system and with their experiments, the system can be developed in such a way that it is easy to use and take into use.

One of the problems that need to be addressed is the ideal way to identify the animal the veterinarian is treating. For livestock, the industry has already stipulated the need for clear identification, thus e.g. ear tags on bovines and swine. Often the identification today is RFID-based, as in the studies by (Trevarthen, 2007; Trevarthen & Michael, 2008; Voulodimos, Patrikakis, Sideridis, Ntafis, & Xylouri, 2010; Wallace et al., 2008). In these studies, apart from the aforementioned article by Wallace et al (2008), the studies have been about the need for bovine identification in business management and the importance of traceability. The main issue in these studies is that via the id-tag of the bovine animal, information about the animal can be traced. Whether with RFID-tag technology a cow’s milk production or a heifer’s movements across the country from various owners can be monitored, the information should be traceable and used from the farm to the slaughterhouse to your table. Since, a horse might end up as a meal for people, the same level of monitoring is required.

Both FEI and harness racing sports have strict rules about medication usage and vaccination requirements. Accurate identification of the animal is one of the key features that are needed to gain trustworthy information. Inserting a microchip identifies horses, but often the standards of various microchip companies vary, so the veterinarian needs more than one reader to be able to identify the horses. In the Australian bovine monitoring systems, the key concept is that the animal can be tracked by their ear tag (Trevarthen, 2007; Trevarthen & Michael, 2008). In this way the animal’s identification can be read from even a larger distance, which is of value when working with animals that might be shy towards people. Today a horse’s microchip is inserted into the neck of the horse, which can be difficult for the veterinarian to read, because some horses get very nervous when a strange person handles it or they might just be skittish around their head. The microchip might also be unreadable, since it can have a different frequency standard than the reader. A horse’s microchip cannot be hanging outside their body, as an ear tag on bovine animals, since it would impair the animal. The question is could a microchip or other identification system be available, which would have one standard, could be read by a mobile phone and be readable from a short distance? Even 1-2 meter reading range from the animal could make a huge difference. The microchips used for horses today only contain the horse’s life number. There is a need to develop horse identification in the direction discussed in other studies such as Trevarthen (2007), Trevarthen and Michael (2008), Voulodimos et al. (2010). In Wallace et al., (2008), the study involved temperature measurements done in horses with RFID tags. This study shows other issues that could be raised with id-tags and veterinary monitoring. One problem that has raised much debate within all the horse sports is the opposition of inserted microchips: Can a microchip implantation cause foreign body reactions or tumour formations? These aspects are not discussed here but the ideas on how a microchip can be used in veterinarian work are presented later. The digitalization of a horse’s healthcare information, as discussed in Wallace et al (2008), proved therefore to be a good basis for the research conducted here.

Since various mobile applications have become popular, and include all types of apps imaginable, there are naturally also apps for physicians. According to studies amongst physicians the most popular m-health apps for iOS devices were medical information references, educational tools and tracking tools (Liu, Zhu, Holroyd, & Seng, 2011). Their research was done in the beginning of January 2011, and can be used as a general guide to what types of m-health applications were then in use. Later in this text I will briefly explore applications that are made for veterinarians, and compare if they relate to the apps physicians prefer and how they compare to m-equine’s web-based support system.

Liu et.al (2011) also found in their m-health research that the apps that took advantage of the smart phones unique features to bring real convenience to the users were amongst the most popular iOS device applications (Liu et al., 2011). The highest ranked m-health apps were therefore various tracking tools, such as health, calorie intake etc. This is largely due to the fact that the app is always available on the Smart phone for the user. The second highest ranked tools were educational and reference tools for medical students and practitioners (Liu et al., 2011). When comparing these results with veterinarians’ needs, tracking would seem to be more of use for the owner of the animal, but reference tools could be of use for a veterinarian. In the apps market there are already a few reference and educational tools for veterinarians and veterinary students such as “Vet Anaesthesia Guide” by Guilherme Caldas, “Veterinary Terms +Plus” by Wan Fong Lam and “VetMed EQ” by FES Solutions (Apple Inc, 2013). The tracking that a veterinarian needs to do of his/her patients can be done at the veterinary office with a computer, and does not necessarily require “anytime & anywhere” access that a mobile device can offer.

METHODOLOGY

The methodology used in this research is a combination of both action research and design science research. The goal is to introduce and understand the veterinarians’ needs and develop a system that would meet these needs. This will require several construction and evaluation phases, to achieve an optimal solution (Cole, Purao, Rossi, & Sein, 2005). Amongst others one definition of this type of research has been described in the article “Action Design research” by Sein, et al. (2011). In their paper they identify four stages that properly identify and sequence Action Design Research (ADR). Stage 1: Problem Formulation, Stage 2: Building, Intervention, and Evaluation, Stage 3: Reflection and Learning and Stage 4: Formalization of Learning (Sein, Henfridsson, Purao, Rossi, & Lindgren, 2011).

The Problem formulation can be divided into two separate approaches, namely “the Practice-Inspired Research principle” or “the Theory-Ingrained Artefact” (Sein et al., 2011). In this research the former has been used. In stage 2, the Building, Intervention, and Evaluation (BIE) are divided into two end points; IT-Dominant BIE and Organization-Dominant BIE (Sein et al., 2011). The IT-dominant spectrum suits ADR, where practitioner and some specialists create the innovative technology. The organization-dominant BIE is ADR that is done by using, as the primary source, the organization to generate design.(Sein et al., 2011)

In Figure 1 the m-equine BIE schema is introduced. In this research the ADR group mainly consists of one researcher. The S1 test group consists of: one county veterinarian, three different equine medicine clinics, two FEI veterinarians and three FEI competition officials during the International dressage (CDI) and Jumping (CSI) event in Tallinn, Estonia. The individuals taking part in the S1 test group were interviewed and their daily activities were monitored and recorded. With the feedback obtained from these discussions, other stakeholders around horses could be approached. The S2 test group consists of riders and owners of competition horses. They took part in an exploratory survey summer 2009, from which the results from this survey were presented in two separate papers (Leskinen, 2010; Leskinen, 2011). With the feedback obtained from both S1 and S2 a proof of concept could be built and introduced to some extent to the S3 test group. The S3 group consisted of Finnish equestrian and county veterinarians partaking in a web-based survey during fall 2010. The following iteration now is to build and launch the m-equine system’s alpha version in accordance to the previous iterations’ collected information. Some of the participants in S3 test group voiced interest to try out the alpha version and are therefore separated to their own group; S3 group 2. After the alpha version has been launched, a new round of interviews and monitoring will be conducted, to evaluate the alpha version and record the veterinarians’ opinions and suggestions. Changes will be made to the system accordingly and this will naturally lead to the next step i.e. a beta version. The final iteration ends with the launching of the commercial version. These iterations will be discussed more with the future research and development.

The three first iterations (I, II and III) are of nature IT-dominant (see Figure 1), whereas the last iteration (IV) has more trademarks from the Organization-Dominant spectrum. The Reflection and Learning stage is part of each iteration loop to learn and identify problems and processes, but also to reflect the problem solving and theories used. Iterations are done until the result equals the set goals of the project. Once this has been achieved, the ADR method is transferred to the fourth stage; Formalization of Learning. (Sein et al., 2011)

Figure 1. m-Equine BIE schema

At the moment the fourth stage, Formalization of Learning, is presented for the alpha version in this paper. Several iterations will concur, until the m-equine mobile system for veterinarians is finalized, first then stage four can be fully explored.

DESIGN AND BUILDING PROCESS

The process on how the design for the system has been done follows the ADR requirements. There are various patient management systems used at veterinary practices and also some apps that have been designed for veterinarians. In Finland equine veterinarian’s mostly use ProVet patient management software which has recently started to provide even a web and mobile support to its customers (www.provet.fi).

Background Information

A brief study of the current app market situation for veterinarians led me to choose to make this system web-based, since an app alone could never cover the broad area of usage and information that is required for a functioning support system for both veterinarians and other stakeholders around horses. Today’s veterinary and pet related apps sold in Apple’s app store and the equivalent store for Android are very similar to what Liu et.al (2011) discovered in their research with physicians. Many vet related applications – as many physician related applications (Liu et al., 2011) – were educational in nature or provided drug information or amount calculations for drug administration. With a brief study there could not be found any direct vet-horse-vaccination related apps. Liu et.al (2011) study did however rise the potentials what even a simple app could have in supporting a physician’s or students work. However, simple apps cannot meet the requirements needed for such a large and complex system as the m-equine web-based support system will be in the future. The mobile devices have though opened up new possibilities to support different type of work, but it is evident that no mobile support system will be of use for veterinarians unless they are included into the development process. Furthermore, since other stakeholders’ needs also have to be satisfied to get the m-equine system to work it is paramount that the developer understands these needs as well. Therefore for this system to work, the developer has to have IT and mobile system knowledge as well as knowledge in the equine sports.

Veterinarians’ Needs

The veterinarians’ needs are the primary basis for the IV^th iteration cycle presented in Figure 1. The previous iterations state the main requirements for the system. To gather information on a veterinarian’s daily routines, use of mobile devices and attitude towards new technological innovations, preliminary interviews were conducted in Finland with a few veterinarians (see Figure 1, group S1). Research on veterinarians’ usage of mobile services to support their work had not been previously done in Finland. After the personal interviews and observations with group S1 and the survey done with the test group S2, three Master’s students (Jorge Lucic, Valentina Muñoz and Luis Rubén Rodríguez) and I conducted an Internet survey with Finnish veterinarians (Figure 1, group S3). These survey results are a basis for the upcoming alpha version of m-equine. Some of the basic findings that will mould the alpha version are the veterinarian’s need to eliminate unnecessary paperwork, improve their time management, and overall positive attitude towards a common database. Although many veterinarians voiced their reluctance towards new technology, many would be willing to try it out, if it were beneficial for their work performances.

One aspect that would be paramount for a successful web-based support system is that it works even outside the clinic environment. Many equine veterinarians as well as county veterinarians make house calls to treat horses. At a stable the environment is not as sanitary as in a clinic, and much work might have to be done outdoors, regardless of the weather. Therefore the veterinarian needs a working system for book keeping during house calls. Currently the data acquired during a house call often has to be inserted into the veterinary clinic’s patient software, billing software etc.

The veterinarians found that vaccination data is something they could share and that it could be shared in a common database (Leskinen, 2012). In a Danish survey conducted 2012 veterinarians and other stakeholders around horses were keen on having a common database, to support equine veterinary care (Hartig et al., 2013). With this information and the information attained from previous studies it is apparent that the majority of all the major stakeholders accept and even desire a common database and services for up keeping and controlling horses’ influenza vaccination. This also complies with the view of FEI and its attempt to facilitate competition horses’ movements across borders (FEI, 2013).

Conceptualization

From the survey, literature and existing cases presented I started to work on how the mobile platform would work. The IS architecture is presented in Figure 2. Although the design and development of the mobile system is in the foreground, a working IT structure and database are equally important. Many Finnish veterinarians still use basic phones but especially the younger veterinarians are accustomed to use smart phones and other mobile devices. The Central Statistical Office of Finland stated that in spring 2011 42% of Finnish consumers in the age groups 16–74 were using a smartphone (Statistics Finland, 7.11.2012). Since the market share for smart phones have increased, it is safe to assume that also veterinarians would upgrade their mobile devices in an acceptable space of time. Therefore, at first the system would be built to work on smart phones or similar mobile devices, but if necessary have some of the functions available for basic phones so that veterinarians would be more inclined to try the system.

General Design

The m-equine architecture is visualized in m-equine system architecture Figure 2. The database and access to it play a pivotal role for a successful system. Since stables today are not necessarily within a good 3G or 4G network, there would be need for a backup system if internet accessibility is not available. All data input done in m-equine, regardless of the interface used, should be simultaneously updated into the underlying database.

Figure 2. m-Equine system architecture

The m-equine system has to be easily accessible for veterinarians and other stakeholders wherever they are. Therefore the system must have an interface for both mobile devices and computers. In the following table the key needs that must be met in the alpha version are listed. The requirements, security and interface options for m-equine have been stated for the main stakeholders, i.e. veterinarian, owner, rider/driver and competition organizer in Table 1.

Table 1. Design requirements for various stakeholders

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