Recently, I spoke with a practitioner who was distraught by the fact that she couldn't export images from her ultrasound machine for telemedicine consultation. The company that sold her the ultrasound machine requires an additional $10,000 to provide her with software and instructions about how to export images. To make matters worse, she was told that the only way to export images is to use their telemedicine service. When she declined, they were unwilling to explain how to export images without purchasing their software. Currently, she is unable to export images from her ultrasound machine. This is an unfortunate example of "vendor lock-in."

"Vendor lock-in" is a common marketing practice. You experience "vendor lock in" every time you purchase razor blades or ink for your inkjet printer. Unfortunately, "vendor lock in" will ultimately limit the flexibility of telemedicine in your practice. As an analogy, I often compare veterinary telemedicine to a digital camera. Most people would not purchase a digital camera from company X if you could only view your photos on a computer made by company X, using software made by company X, and were only able to send your photos to people company X allowed you to, and you had to pay company X a fee for the privilege of sending these photos.

In human medicine the ACR (American College of Radiology) has taken measures to help prevent vendor lock in. The DICOM (digital imaging communications in medicine) standard was created so that images can freely be transferred between imaging devices. Unfortunately, many vendors selling veterinary imaging equipment and services ignore the standards set forth in human medicine.

In veterinary medicine, "vendor lock-in" occurs when a vendor sells an imaging device (such as an x-ray scanner, digital radiography system, or ultrasound machine) which is bundled directly to vendor specific software which the veterinarian uses to manipulate and transmit images for telemedicine consult.

In most cases, veterinary telemedicine services provide a very useful service. These services provide access to specialists and vendors make these services very user friendly. For many practices, the ease of use and access to specialists outweighs the potential problems associated with "vendor lock-in."

However, before you consider purchasing a telemedicine contract or expensive imaging device bundled directly to a telemedicine service consider these questions. Who will support your equipment if the vendor supporting the software goes out of business or no longer supports your imaging device? What happens if the vendor provides a poor telemedicine service? What happens if the vendor fails to upgrade their software during future computer operating system upgrades? What happens if the vendor uses a proprietary imaging standard so you can only open images using their software? In each of these situations you are at the mercy of the vendor. Ultimately, "vendor lock-in" decreases competition and provides little incentive for the vendor to improve their product or provide you with superior service.

To prevent these issues , when purchasing digital imaging equipment ensure that you are able to access your images without using the vendor's software and be sure that you can export images without using their telemedicine service. When purchasing digital imaging equipment you should ensure that:

1. the hardware and the software function as two separate entities
2. you are able to view your images on any PC or Mac without the aid of vendor specific software
3. all imaging equipment is DICOM compatible and you are able to export DICOM images. If you are unsure about the DICOM compatibility of an imaing device, you are encouraged to contact your local veterinary radiologist.

In conclusion, telemedicine can be a tremendous addition to a veterinary practice. Often time, practice owners will decide to use a telemedicine service bundled with a piece of digital imaging equipment. However, be sure that you can easily export and access your images without any additional expensive software, hardware, or telemedicine contracts. In fact, you should always be able to "opt out" of any telemedicine service offered with your imaging hardware and negotiate the terms of your telemedicine directly with the specialist (i.e. eliminate the middle man). This will allow you to decide to whom you would like to refer images, for what price, and how often. Additionally, building a close relationship with one or two specialists (that you can actually call to talk with) will invariably provide you with better service than many telemedicine services can.