35 years of “Best Tech” for Pediatric Practice

I wrote my first technology related article for Contemporary Pediatrics in 1988. The article shared my experience with the first ear thermometer and rapid strep tests- and how pediatricians can use office technologies to improve care. At I write this, 35 years have passed, and I have authored more than 200 practice improvement and technology related articles. Going forward the editors and I have decided to transition the “Best Tech” series into more targeted articles, that will be more helpful to “contemporary pediatricians!” After all, following the COVID-19 pandemic, pediatricians are no longer luddites, and routinely perform telehealth visits, use electronic stethoscopes, and utilize in office molecular tests to rapidly diagnose a variety of infectious diseases.

To celebrate my 35 five years of “Best Tech” articles I am sharing my choice of technologies every practice should utilize to provide the best high-tech care. My opinions are those of my own and do not reflect those of the editors or publisher.

Best electronic stethoscope

Sadly, my favorite electronic stethoscope is no longer being produced! It’s the Littmann 3200, and you can occasionally find these on eBay for about $600. The Littmann 3200 was an ergonomically designed stethoscope that featured ambient noise reduction, sound amplification, digital bell and diaphragm modes, and allowed me to save up to 12 brief recordings of heart murmurs or lung sounds. These recordings could be shared with patients and parents, merely by placing the ear tips in their ears. Unfortunately, the Littman 3200 accounted for just 5% of Littmann’s stethoscope sales, and it was discontinued a few years ago. I have stockpiled several over the years and continue to use my Littmann 3200 all the time. I am not a fan of stethoscopes that allow display of a simultaneous phonocardiogram or EKG while auscultating, as dysrhythmias are not as frequent in pediatric patients as they are in adults. The new Core 500 from Ekohealth looks promising as it shares features of the Littman 3200 and can transmit auscultated sound to my Bluetooth hearing aids wirelessly.

Best devices for detecting Otitis media and hearing loss

One of the best kept secrets in office technology is the Acoustic Otoscope, from CheckMyEar.com. Introduced in the 1990s it’s a handheld device that is positioned in the ear canal much like an otoscope. With the press of a button the device emits a series of chirps and seconds later a sensitive microphone records a measurement called the spectral gradient angle. The measurement indicates whether there is fluid in the middle ear space. The Acoustic Otoscope takes seconds to record a measurement and quickly indicates whether an otitis media or otitis media with effusion is present in the tested ear. Best of all the measurements are reimbursable at about $25. The device costs $895 and a set of 100 disposable ear tips costs $75. If you do 2 tests per day, you will recoup your investment in just a month.

What about screening for hearing loss? Simpler is always better and I continue to prefer the Welch Allyn OAE series 39500 screener. Easy to use and very quick! It serves as a complementary device to Hillrom’s current top of the line Macroview Plus Otoscope, which now provides greater magnification and more illumination than previous models. And if you want to share observations with patients you can’t do better than the Wispr Digitial Otoscope, that facilitates capturing photos or videos of the ear canal and tympanic membrane.

Best thermometer

Back in the day, digital oral, axillary, and rectal thermometers were replaced by “ear thermometers” that were used to screen for fevers in children as well as adults. Given my interest in technology and my proximity to Exergen Corporation’s Massachusetts office, my practice was used to help refine their infrared ear thermometer. Now their temporal artery TAT 5000S thermometer is a staple of medical practice. It is incredibly inexpensive, tough as nails, and comes with a lifetime warranty!

Best Applications

For as long as I have owned a smartphone, Pedi QuickCalc application has been one of my favorite applications. Now in version 5, the app provides quick conversion from kilograms to pounds, easy access to weight-based medication dosages, bilirubin measurement plotting, and much more. At $4.99 these is no greater value.

I also recommend Pediatric SymptomMD from Selfcare decisions. This was created by Barton Schmitt, who developed the standard pediatric triage protocols we all use. I always encourage parents to use this regularly. It costs $2.99 and lists dosages of common pediatric OTC medications and answers most routine medical questions. Over the years, Pediatric SymptomMD has saved countless unnecessary after-hours phone calls from worried parents.

Lastly, as I care for many patients with ADHD, meHealth.com from Cincinnati Children’s Hospital expedites completion of Vanderbilt forms by parents and teachers, and scores these automatically. Using MeHealth I can complete an ADHD evaluation in days or weeks, rather than months as was commonplace when we used paper-based forms. And for patients with anxiety and depression one cannot do better than CHADIS, developed by Drs. Barbara Howard and Raymond Sturner. It expedites completion of screening forms for a wide variety of mental health conditions as well as developmental delays and is quite affordable and easy to use.

Pulse oximeters and more

I’ve always been a fan of most oximeters from Masimo. It uses what Masimo calls “signal extraction technology” to facilitate oxygen saturation measurements, even in uncooperative, squirmy children. It also provides respiratory measurements and perfusion index. My favorite is the Rad-G device, which works well with their pediatric sensors. Their more expensive Rad-67 model measures these parameters and can also be used to measure a patient’s hemoglobin.
For vision screening I have been using the PlusOptix S12C. Screening is easy to perform, reimbursement is very reasonable, and I’ve identified lots of patients with amblyopia who have benefited from early identification and treatment.

For telehealth visits I prefer Doximity’s Dialer which is embedded in the Doximity application. It masks your cell phone number with your office’s phone number and sends an invitation to the patient’s SMS application. If a patient does not get online, you can use the “nudge” feature to place a voice call to the patient to remind them of the visit. It is quite affordable and can be used with computer systems as well as mobile devices.

Thanks for reading!

I’ve always enjoyed tech related conversations with pediatric colleagues. If you have any questions or would like to discuss your own recommendations, please email me at Andrew. Schuman@ymail.com. I will continue to produce reviews of interesting devices and applications via my Medgizmos.com web site, so as always – stay tuned.

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