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!
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!
Steve Jobs introduced the SmartPhone in 2007 and there are now many “connected” devices that have transformed smartphones into medical devices. We now have connected pulse oximeters, glucose monitors, otoscopes and dermscopes, to name a few. AliveCor has met with significant success with the introduction of their KardiMobile device/application and the KardiaBand that transforms the smartphone into a portable EKG screening tool.
As discussed in the video, the KardiaMobile device consists of a small sensor strip upon which one places one or two fingers of both hands. The application then records an inverted lead EKG that is from 30 seconds to 5 minutes in length. This can be reviewed on the smartphone and even transmitted to one’s physician as a pdf file so it can be included in the medical record. The EKG can also be reviewed by a cardiologist at cost of $19.
The device and application is appropriate for screening for dysrhythmias or monitoring already diagnosed dysrhythmias in a patient. The cost of the device and the application is $100 and is approved for patients 18 and above. It works with android and IOS smartphones and tablets.
More recently AliveCor introduced their $200 KardiaBand for use with the Apple Watch. One activates the watch application and holds a thumb to a sensor on the band. A thirty second recording is then recorded and transmitted to the KardiaMobile application which can be reviewed and shared.
There is a lot to like about the DUO digital stethoscope from Eko. First and foremost, the device is an excellent digital stethoscope that amplifies auscultated sounds up to 60 times. It utilizes inductive charging to recharge the internal battery. In addition it integrates with a smart device application via Bluetooth to adjust the listening volume and stethoscope filter and record auscultated heart sounds. The device also adds the capability of displaying and recording a one lead EKG.
As shown in the video the application can capture either the auscultated heart sounds, the EKG alone, or both together. You can save a recording to the cloud from the application. When you sign into your Eko online account you can view all recordings, play them back, share recordings with others, or save the file as a pdf. To record an EKG the Eko is placed on the chest – but I’ve discovered you can more easily flip the DUO upside down and have the patient place one finger from both hands on the metal plates surrounding the diaphragm area. This provides an EKG with less interference compared with that produced when the stethoscope is placed on the chest.
The device is very affordable at $349. A selection of ear tips is provided. In the near future the Eko app will be upgraded so it will be able to use AI to facilitate diagnosis of various heart murmurs.
Great device and worth your consideration. As always stay tuned!