Veterinarians’ Perceptions of Online Services

The purpose of the study is to evaluate the perceived usefulness of online materials from a veterinarian’s perspective. The authors used an online questionnaire that was posted on the homepage of a Veterinarian News site. Questions were based on previous publications and added contemporary services such as remote pet monitoring by means of wearable electronic devices. According to our study, the perceived usefulness of online services can be condensed into four major dimensions: 1) Authoritative Knowledge & Updates; 2) Practical Online Content delivered by webportals; 3) Remote Monitoring/Tracking of pets; 4) Health Coaching. The findings have implications for the cooperation between suppliers and veterinarians. One size does not fit all. Veterinarians want to use digital media for receiving competent personalized advice in order to sell it on to their customers. Suppliers will have to provide unbiased advice to compete for veterinarian’s heart share instead of simple market share.

conducted a study on the quality of e-tourism through websites based on the ten SERVQUAL elements including reliability, access, responsiveness, ease of use, security, tangibles, trust, personalization, credibility, and empathy; in their opinion a website should incorporate some type of recommender system for mass-customization.
Hadwich et al. conducted a study on the service quality of e-health including accessibility, competence, information, usability/user friendliness, security, system integration, trust, individualization, empathy, ethical conduct, degree of performance, reliability, and ability to respond. Another study focused on hospital websites and found that websites must provide quality information and have to interact effectively as communication mediums for service transaction and support to their patients and other related stakeholders such as citizens, health-care professionals and local communities.
Services provided for Animal Health-Care Professionals (AHCP) is lacking behind Human e-health.
Digital services in Human e-health are estimated to lagging 3-4 years behind other service industries. A time lag of 5-6 years for animal health seems realistic.
IMS Health reported that the deployment of digital channels has increased by 30% in 2014 (inclusive of online retailing, emailing and video streaming), with the traditional singular approaches of influence and advertising moving towards a more integrated approach across multiple touch-points and platforms designed for engagement, rather than unidirectional.
Emerging markets such as China and Brazil have seen double digit increases in animal health marketing budgets, however conversely, other major European markets have seen significant cuts; mirroring this, the number of Account Managers has increased in Asia Pacific (APAC) and Latin American Markets at 9.5% and 1.6% respectively, and conversely in European Markets numbers have declined at 4% in recent years. Despite variations in marketing expenditure globally, there is consistent investment across all countries in the digital channels. Klie estimates that 25% of personal interactions with veterinarians (vets) can be replaced by digital media. Dobrow reported that 86% of companies are using digital channels to target Health Care Professionals (HCP), utilizing media such as websites, e-detailing, social media, digital ads and mobile/tablet apps. A survey among 200 executives from pharma, biotechnology, devices and diagnostics companies found that Business-To-Business (B2B) marketing budgets (to HCPs) account for 75% compared to 25% B2C.
Ising and Munie see digital media as the driving force for growth and profitability in the pharmaceutical market. Quantia MD and Capgemini Consulting surveyed over 1,756 physicians, as well as drew upon knowledge from a previous study (with a sample of 630 physicians) and found that the major channels in which physicians prefer to receive information is by: Independent medical websites and communities communities are perceived as an unbiased source of information. Research by Bain estimates that by the end of 2017, 93% of physicians in the U.S.A. will be using electronic medical records and 97% will have access to electronic treatment protocols.
Touted as the upcoming area of promise, "big data" is set to improve (animal) health care and decrease costs. It is predicted that diseases may be able to be detected earlier, leading to treatment interventions at an earlier stage resulting in more effective outcomes in managing both individual patients and large populations. The types of needed data are high volume, high diversity, biological, clinical, environmental and lifestyle information in relation to health and wellness status. Data may include clinical data from HCPs, imaging, laboratories, pharmacies, insurance companies, machine generated/sensor data, and even social media posts as long as they comply with personal data protection. Increasingly pet owners are turning to the internet to research information about their animals. Kogan et al. found of those that use the internet, 13.4% use it to search for pet health information on a weekly basis, and a further 24.2% using it on a monthly basis. Reasons cited for the most frequent use relating to pet health information searches include: curiosity (47.4%) and the desire to clarify information received by their veterinarian (33.6%), though it was considered as a complement to their veterinarian's advice rather than to replace it.

Materials and Methods
Online services can support veterinarians in many ways such as recommender system, medical calculations, information on websites, interactive webinars, etc. The literature review has shown that the uptake of such online support is relatively low. Pharmaceutical companies offer online services (e.g., e-detailing, webinars) to support veterinarians but it is the perceived usefulness that determines the usage of such support. Figure 1 shows the research framework.  Table 1. Most veterinarians were between 20 and 60 years old, see Table 2. The questionnaire covered 16 items. Ranking was in form of a Likert scale from 1 (totally unimportant/fully disagree) to 5 (very important/fully agree). Table 3 lists the importance of services as perceived by the veterinarians. Highest ranked service was webinar. The corresponding statement was "I would find a 20-30 minute webinar run by a specialist in a disease/therapy area followed immediately afterwards by an interactive 20-30 minute online discussion forum to ask questions useful". Important to understand that such webinar is hosted by a specialist and must not being sales pitch. Second most important service is Update.

Ranking of Digital Services
The statement reads as follows "I am interested in receiving communications about the latest updates in a disease/therapy area in the form of technical newsletters delivered via email on a fortnightly or monthly basis". Again, it shows the need for competent and objective information that helps the veterinarian in his/her daily work.
Findings are in line with Huntley et al. who surveyed 6,310 veterinarians and found that most prefer seminars (49.7%) followed by conferences (23.4%), and online courses (8.7%) as support functions.
Since our survey looked only into digital media it is unsurprising that the digital form of a seminar, the webinar, ranked highest.
We will discuss the other items later in the context of a Factor Analysis.

Group Differences
Above veterinarians seem to be a rather homogeneous group of people in regard to their online service expectations.

Factor Analysis
Factor Analysis is a data reduction method. It condenses many variables, in our case the 16 questions, into major underlying factors. In our analysis we used Principal Component Analysis followed by Varimax Rotation with Kaiser Normalization. The 16 questions resulted in 6 Factors (Dimensions), see Table 4. Not all factors carry the same weight. Factor 1 can explain 14.4% of total variance and is therefore the most important one. A factor loading is nothing else than the correlation between the question and the factor, e.g., Video_Comms correlates with factor 1 with 0.708. We regarded any loading close to 0.7 or higher as high and therefore worth interpreting. Factor 1 can be described as the "objective News Updates" Dimensions. The three high loading statements are: "I am interested in receiving communications about the latest updates in a disease/therapy area in the form of 5-10 minute videos on a fortnightly or monthly basis".
"I would find a 20-30 minute webinar run by a specialist in a disease/therapy area followed immediately afterwards by an interactive 20-30 minute online discussion forum to ask questions useful".
"I would be interested in engaging in an ongoing online discussion forum for veterinary professionals in a disease/therapy area facilitated by key opinion leaders (sponsored by an Animal Health Product Supplier)".
Factor 2 can be called the "web portal dimensions".
The statements were: "Pet owners cite the internet as the third most common place they look for information about their pet.
Often the information found can be misleading. In a recent study conducted, 93% of pet owners reported that receiving a website recommendation (also known as an information prescription) from their veterinarian at the time of a consult was an excellent idea and 83.5% felt it added to the advice of their veterinarian after attending the appointment. In knowing this, where I know of a credible website, I will give pet owners a website recommendation (information prescription) for the majority of my consults and integrate it as part of my consultation routine".
"Having a reliable general pet health information portal, e.g., a website, which I can direct my clients to about the benefits of preventative health-care, that is accredited with respected industry bodies like the British Veterinary Association or British Small Animal Veterinary Association is important to me".
Factor 3 can be called the "Hardware dimensions".
Supported Statements: "I think that wearable fitness trackers (monitoring heart rate, respiratory rate, temperature, and activity levels to name a few) for pets has great potential to be used as a supplement in monitoring health conditions".
"I would be interested in remote monitoring of my patients with specific chronic conditions and being fed back real time data. For example, having an application that allows the client to monitor a diabetic patient remotely, with information being transmitted electronically back to me so that I can check on his/her progress, e.g., Blood glucose spot checks being performed at home by the owner, with weight, water intake, food intake, insulin dose given, being recorded". Factor 4 can be called the "health coach".

Supported Statements:
Once a patient is diagnosed with a chronic condition and started on medication, I feel that ongoing advice, support and emotional counseling in the form of a "health coach" is important in the initial starting phases to help a client through these unsettling times. Trained human nurses have been used with great success in such programs, for example, in the area of diabetes. In veterinary medicine, a trained diabetic nurse adviser could help guide a pet owner once their pet has been diagnosed on things such as how to www.scholink.org/ojs/index.php/rem Research in Economics and Management Vol. 3, No. 3, 2018 182 Published by SCHOLINK INC.
give injections and signs to look out for when too much insulin is given. I believe that patient support programs run by veterinary technicians and nurses through regular in clinic consults, and/or via the telephone or virtual calls (e.g., Skype) would help in improving patient health outcomes.
"Marketing what the practice does and engaging with the local community is important to me".
Factor 5 and 6 have one high loading statement each. For factor 5 it is: "I would prefer only electronic communications only, e.g., emails or SMS" For factor 6: "The practice I work at have a defined marketing strategy/plan for 2017/2018".
They are the least important factors.

Discussion
Although often under time pressure, veterinarians are eager to continue learning and are looking for independent and authoritative advice. Even a one hour webinar seems acceptable as long as it delivers independent advice and time for peer discussion. Discussions with peers and specialists in real-time can enrich such webinars. There are nine webportals that focus solely on webinars for veterinarians.
However, almost all webinars are sponsored by pharmaceutical or related companies. There are non-commercial webinars for students but not for practitioners. The survey results show that lifelong learning expectations of veterinarians are different from university level training. The veterinarian's needs are closely profession related. Therefore, there is a latent demand for truly independent webinars that are hosted by independent specialists. Sponsored webinars cost around US$ 50 so one can assume that veterinarians are willing to pay at least that amount for a truly independent one.
Animal healthcare suppliers should have authoritative websites with content that the veterinarian can recommend to his/her client. For example, wearable tracking devices was an area that veterinarians are interested in and want to learn more about. Such devices and the accompanying software that analyses the huge amount of data and recommend appropriate next steps is readily available. One can even think of competitions to add an element of gamification to animal health, e.g., rewards for walking a certain distance with a pet.
Health coaches are typically humans such as nurses. The more the area of AI develops the more human like virtual nurses will become. One example is Watson by IBM. The fear that such systems may become so sophisticated that they will replace human veterinarians and nurses seems slightly overblown. AI and its impact on health coaching is an area that veterinarians may want to learn more about.
It will need quality assurance. For webinars and online courses, the E-S-QUAL, the SITEQUAL or the e-SQ model should be applied. Veterinarians can conduct a self-assessment of their competencies.
Clients can be asked to fill in the SERVQUAL questionnaire and rate the veterinarian along the dimensions of reliability (providing the promised veterinarian service), assurance (trusting the veterinarian), tangibles (using modern equipment), empathy (offering convenience), and responsiveness (always being available). Besides formal training there are informal learning sources such as interacting with peers and clients.
There are limitations and scope for further research of our study. Firstly, the sample has an Anglo-Saxon bias. Secondly, the results are limited to online services and exclude face-to-face training. Thirdly, recommendations are based on veterinarian's perceptions and as such they reflect an amalgamation of subjective opinions. Fourthly, the readership of the veterinarian news site where the survey was posted might not represent the veterinarian community at large. Fifthly, we looked at demographic differences such as nationality, age and gender but not at a veterinarian's lifestyle.
Despite these limitations we can conclude that veterinarians are eager to keep up-to-date. Often bombarded with commercial sponsoring they value genuine advice and are willing to invest time for keeping up with latest developments in their therapy area and technology. Our research did not find any age differences, i.e., a more senior veterinarian is as open to learn new things as a younger peer. Probably the area where veterinarians want to update their knowledge the most, apart from updates in their specific disease/therapy area, is technology such as remote tracking devices, big data, and AI.