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.
ScopeAround Wifi Otoscope, new inexpensive digital otoscope!
Physicians usually pay top dollar for medical equipment, so I was quite surprised when I acquired the Scope Around Wifi Otoscope from Amazon for $35 dollars. A patient sent an image of a child’s TM using this device via our EHR’s portal and I was quite impressed.
The ScopeAround is made by a Chinese company that makes a variety of fiberoptic “clinical cameras” for personal use. The WiFi Otoscope has built in Wifi and to use the system one connects to the Otoscope’s wifi access point. One then launches an application called BK WiFI to see what the Otoscope visualizes. One can record photos or videos. The lighting is quite effective, and images are 720p resolution. Cleaning swabs are provided along with alcohol wipes for cleaning the lens. It is used in conjunction with a speculum with is included in the system. Also included are tips of varying shapes and lengths that can be used to remove soft cerumen. The fiberoptic camera does generate some heat but it is warm to the touch, but not hot, so it is wise to caution patients about this prior to using the camera.
Take a look at the ScopeAround.com web site to see the other clinical cameras they provide. Many integrate 1080p resolution screens attached to the camera so one does not need to connect to a smart device to use these otoscopes.
It is also a good idea to recommend that parents consider purchasing the WiFi Otoscope for the otitis prone child. This enables physicians to utilize Telehealth visits for evaluating children with ear pain as the images can be easily transmitted via email from parent to physician!
I’ve been using digital stethoscopes for decades and have been very pleased that new devices are being introduced with regularity. There is a lot to like about the HD Steth from HD Medical group. It features a rechargeable battery, high quality tubing and ear tips. It is comfortable to use and has a bright blue screen. It is easy to turn on and off, boots quickly, and enables users to adjust volume with a press of a button. It features 3 auscultation modes, diaphragm, bell, and lung. As you would expect it provides ambient noise reduction as well as amplification. In addition, like most digital stethoscopes these days it communicates with an application (android now, iOS coming soon) that enables you to record auscultated heart sounds and display the recordings as a phonocardiogram. It also enables a provider to record an EKG via the application for later review and sharing with cardiologists as appropriate.
The HD Steth costs $500 and is a worthwhile investment for primary care providers who wish to improve their auscultation capabilities!
There are now 63 state, regional, and city-based vaccine registries, called Immunization Information Systems (IISs), each operating independently under its respective local and state policies. It is the responsibility of the administering site to enter the required data and it can be a burden to staff when they need to enter the data in multiple locations such as the registry, the EHR, and the patient vaccination card.
One method of speeding data entry is the integration of bar code scanning into EHRs. After receiving a shipment of vaccine, the shipment form is scanned into a vaccine inventory which is integrated into the EHR. At a patient visit the provide orders are placed and the vaccines retrieved and scanned once more. Warnings appear if the vaccine is being given too soon, not age appropriate, or issued by the wrong funding source (eg Vaccines for Children program), or the vaccine has expired. The staff manually enters the vaccine administration information into the EHR, and the information is electronically sent to the appropriate IIS. Over the next few years, it is anticipated that a growing number of EHRs will have this capability.
I can tell you that in many pediatric offices, it is very time consuming and unwieldly for staff to enter vaccine information in multiple systems. One startup company, called Canid has a novel approach to facilitating IIS entries for pediatricians. The founder and CEO of Canid, Pedro Sanchez de Lozada, recently sat down with me to discuss IISs, and how the current IIS entry system can be improved.
Canid is establishing relationships with pediatric practices in the New York City area, where the company is located, and eventually hopes to expand services nationwide.
As discussed in the video interview, Canid helps practices acquire vaccines and has developed a software system that either integrates with popular EHRs or facilitates data entry into EHRs by providing a data file that is uploading into an EHRs on a daily basis. The Canid system keeps track of a practice’s vaccine inventory, replenishes supplies when appropriate, and most importantly monitors patient appointments so that a child receives all necessary vaccines. They do this by distributing barcode scanners (see above) that integrates with their proprietary software platform. When vaccines are ordered and taken out of a refrigerator or freezer, they are scanned, and fields are populated into a practices EHR (assuming the EHR supports Canid integration). Little or no manual entry is needed.
We discuss quite a bit in the video, and the conversation is quite enlightening. At the moment, Canid is assisting healthcare professionals in NYC make appointments for administration of Covid vaccines.
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!