The Technology Review Site for Primary Care Providers
Advances in technology have improved healthcare providers' ability to rapidly diagnose patients at the point of care, screen for common conditions, and provide a variety of effective treatment options. Providers need to be aware of what innovations are available - or will become available in the near future. It is the purpose of Medgizmos to educate and inform healthcare providers regarding the latest and greatest technologies.
Clarius mobile Ultrasound system facilitates POC diagnoses!
The Covid-19 pandemic has created an opportunity for the engineers at Remmie Health to develop and begin distribution of an inexpensive ($150) otoscope that can be used to capture images of the tympanic membranes and throat of an ill child or adult. The Remmie Otoscope is now available on Amazon and is designed to be non-threatening to children. It complements ear or forehead thermometers that are likely used routinely by parents to screen children for fever. The Remmie Otoscope transmits images to a mobile application which then can be sent to a child’s physician for review.
Several years ago, the CellScope Oto otoscope was developed to enable smartphones to be used as an otoscope. However, it was awkward to use even though the images it captured were of high quality. Because the camera’s associated with smartphones changed so rapidly, it was difficult for the company to produce the plastic adapters necessary to connect the device to smartphones, and sadly the company went out of business.
As more and more physicians have adopted Telehealth, I anticipate that the Remmie Otoscope will prove useful for the Otitis prone child, as physicians can now diagnose otitis media or pharyngitis remotely. It can also be used to detect impacted cerumen, otitis external, and visualize ear canal foreign bodies.
Remmie Health is now working on developing a Software development Kit (SDK) so Telehealth platforms can integrate the device into their software by developing an application programming Interface. In my view, a provider should recommend that families consider acquiring the device and using it in conjunction with your Telehealth visits, as it will reduce much of the guess work when evaluating an ill child.
As a pediatrician I routinely care for children with asthma. As we all know families of asthmatic are frequently non-compliant with our recommendations – and many children do not take their medications as prescribed. As a consequence, asthmatic patients may have exacerbations, or may in fact be unaware that they are not optimally managed. Furthermore, when such patients begin to wheeze, they may not seek care from their primary care physicians, preferring to be seen at more convenient urgent care clinics or, all to often at an emergency room.
VitalFlo is a company that will enable physicians to better care for their asthmatic patients as well as older patients with COPD and other respiratory conditions. It combines a high-tech spirometer that is provided to your patient that communicates with an app on a smartphone. As seen in the interview with Wendy Stevens BSRN, Director of Business Development for VitalFlo, the app is easy to use, includes a tutorial for using the spirometer, a very brief survey of symptoms, and directs the patient to produce 3 good blows into the device. Patient results are transmitted to a portal that can be viewed by patient or clinician and recommendations can be discussed with patients via office or Telehealth visits. Depending on disease severity the provider makes recommendations regarding the frequency of testing. Vitalflo is a prescription-based service that costs a practice $35 per patient per month (less if the patient purchases the spirometer). The provider can generate revenue by charging for testing/monitoring (billing codes and reimbursement are discussed in the video), and seeing patients for regular visits.
The system was developed at several academic institutions in North Carolina, and studies have demonstrated its ability to improve patient management.
I’m very impressed with the VitalFlo system, and will include it in my “Best Tech for Pediatrics 2021” article that will be published by Contemporary Pediatrics in September!
GoCheck Kids is upgrading their mobile vision screening application to the iPhone platform this year and I’ve been fortunate to have a sneak peek.
Rather than buy a photoscreener that costs upwards of 6 thousand dollars and may be obsolete in a few years, GoCheck Kids offers primary care providers a subscription based photoscreening service that is difficult to pass up. Just $99 per month for unlimited screens. Already over 2500 physicians have enrolled in their service.
The iPhone application is a major improvement upon their previous, Windows Phone version. First the iPhone 7 plus is 5.5 inch in size which makes it easy hold. With the new application, coupled with the larger screen size, users can quickly login and launch the application.
To perform the test – you enter the patient’s name and date of birth and then click the start screening button. You need a moderately darkened room to perform the screen. The application makes animal sounds to hold the patient’s attention as it guides you to move an appropriate distance from the patient. The sides of the screen display green when you are ready to click the screen button and display the result. The result can then be printed, faxed, or saved as a pdf file.
As if by magic the test is uploaded to the cloud via the iPhone’s wireless connection so it will appear in your practice’s GoCheck Kids portal. This makes it very easy to review with the patient’s parent and print out the result so the parent can bring the test with them when they see the ophthalmologist.
In my experience, the photoscreening CPT code of 99177 is reimbursed by most insurances at approximately 21-$25 dollars per screen. I start screening at age one and yearly until the patient can comply with a standard Snellen eye chart screen, which is usually about age 4-5. As 2% of young children have amblyopia it is very important that you begin screening for this treatable condition if you have not already done so!
I’ve been using Dragon Medical for years and each iteration improves on the previous version. Nuance recently released Dragon Medical One and it is truly wonderful. No longer do you need to “train” the software. With your first use – the accuracy is terrific. This version is server based and users install an application on their smartphone to enable the phone to function as a wireless, network connected smart microphone.
The application enables users to assign commands to different “buttons” so you can choose to move from one field to another, activate voice macros that insert templates or move to different areas of the EHR.
One can dictate twice or three times the speed at which one types. This means than once you become facile with Dragon Medical One – you complete your notes much faster than you can by typing. This means that you can complete notes before the end of the workday. No longer will you need to take work home with you. The need for completing notes at home is a major cause of provider “burnout”.
It is worth your time to not only to become skilled in dictating notes, but to take the time and effort to develop macro voice commands that insert phrases, templates, or navigate within the EHR or within the operating system. You should read the manual (of course) which will quickly educate you how to delete or replace phrases, correct words or add words to your vocabulary. Outstanding!
When patients or parents call, practices should have a triage system in place to make sure that patients receive the appropriate level of care (office, emergency room, home care), and are seen in a time frame appropriate for their medical condition (urgently, same day, within a few days).
Approximately 30% of calls received by pediatric practices are for nurse triage. It is very important that office nurses use established protocols when triaging calls, and carefully document each encounter. As most practices use EHRs – nurses needed to document within the patient’s electronic chart. As we know many of our EHRs are labor intensive, and often take longer to complete compared to a simple handwritten note.
Following triage by an office nurse, 57% of patients just need home care advice, 21 % are seen the same day, 16 % are seen within 3 days, 3% are sent to the ED or urgent care, and just 0.1% told to call 911. The remainder are given other dispositions (seen in office within few weeks, call specialist, call dentist, etc.) While this office triage is sometimes time consuming, it is the best method to identify the level of care needed for the child of a concerned parent. This is not only good care, but it also reduces liability of the practice.
Over 6 years ago David Schmitt developed ClearTriage, a web based portal that facilitates the process of triaging patients by medical practices. The system integrates Dr. Bart Schmitt’s telephone triage protocols to expedite the process of triaging office calls as well as documenting recommendations.
ClearTriage is very inexpensive at just $49 per month per concurrent user and was one of my “Best Tech” selections in 2015!
David Schmitt discusses the history behind ClearTriage in part 1 of the video interview and demonstrates its use. Part 2 of the interview presents information about Covid-19 protocols and David’s new product called SymptomScreen. This is a web portal that helps nonclinical office personnel to screen incoming calls to determine if an appointment should be made or the call should be handled by a triage nurse. Great idea, easy to implement and very affordable, and likely to be selected as one of my “Best Tech” selections for 2021!