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!
Nuance Communications, the company that pioneered voice detection software for medical practices, partnered with Microsoft in 2019 to develop an “ambient clinical intelligence” system, called the “Dragon Ambient Experience” or DAX for short. DAX uses an application running on a smartphone, either alone or in combination will a wall mounted “machine vision” camera and 16 microphone array to record a patient’s visit with a physician. The information is transferred to Nuance’s cloud based Artificial Intelligence system which analyses the captured recording and creates an office note. The note is reviewed by Nuance technicians, and then transmitted into the physician’s electronic medical record for review and signature. Now available for use in clinics by specialists and primary care providers, in the near future DAX will be available for use in hospitals and will facilitate note creation by nurses and other support staff- as well as providers. As the system enables providers to see more patients per day, DAX virtually pays for itself.
My interview with Jared Pelo MD, Nuance’s Chief Information Officer, Ambient Clinical Intelligence, is wide ranging and discusses the evolution of DAX, as well as how it is used in a clinic environment. I think you will find the discussion interesting and even provocative – as it provides a look into healthcare’s promising “virtual” future.
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 long been a fan of digital stethoscopes, in part because they improve my ability to auscultate lung and heart sounds, but also because they advance the iconic device that has been associated with medical practice for centuries. To be fair my hearing is much poorer now that I’m in my third decade of medical practice, and my Bluetooth hearing aids help enormously. For some reason very few of my colleagues have moved beyond their acoustic stethoscope and adopted digital devices. I can tell you that digital stethoscopes vastly improve my diagnostic capabilities when it comes to subtle pneumonias and I find I need to order fewer x-rays than other pediatricians. I can also hear murmurs more clearly as well.
The Eko Core Stethoscope system includes the Eko Core Attachment and a capable two headed stethoscope system. It integrates a lithium battery that charges via a microusb port that powers the device for up to 9 hours. When not turned on the stethoscope functions as a typical acoustic (ie analog) stethoscope. When turned on the device amplifies auscultated sounds up to 40 times. While it does not have ambient noise reduction, unlike some of its competitors, the sound quality is very good and switching between the two modes allows you to appreciate the difference between acoustic and digital amplified modes. While you can purchase the Eko Core Stethoscope System for $299, you can purchase the Core Attachment for just $199 and attach your own stethoscope headset, tubing and stethoscope head to the device. Eko health states that the Core Attachment is compatible with most stethoscopes currently on the market.
The Eko Core Attachment/Stethoscope system integrates Bluetooth connectivity to allow recording of auscultated sounds via the Eko application on IOS or Android devices. Thus one can record auscultated lungs sounds or murmurs. Auscultated heart sounds are displayed as a phonocardiogram via the application.
I previously recorded a review of the AliveCor KardiaMobile Device and KardiaBand on Medgizmos. These are FDA cleared for recording an EKG on the Apple Watch series 1 through 4, up to 5 minutes in length which can be interpreted by a cardiologist and transmitted to a patient’s physician. Now Apple has integrated EKG support into its series 4 Apple Watch. The application is free of charge in contrast to the AvliceCor devices and KardiaBand which now sell for $100 each.
The Apple EKG is limited to a 30 second recording. It integrates into the Apple Health application and displays the recording upon completion, this can be saved as a pdf file which can be emailed to the patient’s physician. The apple watch apple is very nice because it allows patients to record symptoms that may be associated with the EKG such as fatigue, shortness of breath or palpitations. It even allows patients to activate a 911 emergency call (also demonstrated previously on Medgizmos ).
The Apple Watch and associated Apple Health application allows patients to record activity, nutrition and sleep activity. In the future the watch may have the capability to record blood pressure measurements as well as transcutaneous glucose readings and perhaps even pulse oximetry readings. Stay tuned!