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!
Primary care physicians have been using Welch Allyn diagnostic sets for decades.
In 2008, Welch Allyn introduced the MacroView otoscope with improved magnification and increased field of view compared to traditional otoscopes. At the time it was a major improvement upon previous versions. It provided a nearly complete view of the tympanic membrane, included a rotating wheel to adjust focus, used a longer lasting halogen bulb, and it optics produced a cool light without reflections. Three years later the company introduced the PanOptic ophthalmoscope with a much wider (5x) view of the retina compared to traditional ophthalmoscopes.
In 2015 Hillrom acquired Welch Allyn, and this year they are upgrading their diagnostic tools.
The new MacroView Plus Otoscope uses LED lighting and improved optics to provide up to 3x the view of traditional otoscopes, a focus free design, and the capability of attaching to a smartphone with a SmartBracket accessory so that tympanic membrane images can be captured and magnified via their iExaminer application. In addition, the MacroView plus can be used with Hillroms new Lithium Ion Plus battery handle that is charged via an usb-c port. They have also released the new LumiView clear, single use speculum, providing up to 8x brighter views compared to those provided by a black speculum. Lastly, their new PanOptic Plus ophthalmoscope uses longer lasting LED lamps to provide up to a 20x larger viewing area when compared to the view through a standard scope. It also integrates their Quick Eye alignment technology to help direct patient gaze during the examination. Online the handle sells for $286, ophthalmoscope for $841, and Otoscope for $455, and a bag of the Lumiview specula sells for $342. A new diagnostic set (new Lithium Ion Plus battery handle, MacroView Plus otoscope and the PanOptic Plus Ophthalmoscope is selling online for $775 without the SmartBracket and $830 with the SmartBracket.
A significant update to provide clinicians with a better view of eyes and ears……
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 old-fashioned way to communicate with patients is via letter or phone call. Too often patients who wish to schedule an appointment or ask a physician a question, have long waits on hold. Patients get frustrated and often consider seeking care outside of their medical home. Additionally, physicians who return calls to patients, encounter full mailboxes and waste precious time leaving messages for patients. What follows too often is an endless game of “phone-tag.”
The best method of communicating with patients, given today’s technology, is via a HIPAA compliant messaging system such as Gnymble, detailed in this video interview and demonstration of the system. Gynmble was developed by Bryan Fine, a pediatrician and entrepreneur. The interview with Dr. Fine and Kaylee Niederhelman, Gnymble’s Director of Business Partnership discusses the nuances of Gnymble. One can message a patient or broadcast a message to many patients. One can copy and paste messages into the office notes. You can even customize your responses with the names of the parents, and patients, and include images or files to enhance communications.
The system is very affordable and should be considered by any primary care or specialty practice who wishes to improve communication with patients.
Every medical practice must dispose of medical sharps. One can use one of a very limited number of medical sharp disposal services or process your medical sharps on site. When I was in private practice over a decade ago, I processed our sharps by using the Medical Waste Machine from Medical Innovations Inc. The system uses locked Teflon lined metal containers that placed in examination rooms and anywhere sharps are used. When these containers are filled, they are opened, two plastic discs are inserted, and the container locked and placed in the Medical Waste Machine.
The device is locked and turned on, heating the container to 380 degrees Fahrenheit, melting the plastic discs, sterilizing the sharps and encapsulating the waste in a plastic block during a four-hour period. This is placed in your regular trash.
Nothing could be easier and more affordable!!!
In our three provider practice, we performed this process once per week. The machine and containers are a one-time purchase, and our practice purchased plastic discs two or three times per year.
David Freedman interviewed in the video has been operating Medical Innovations for 25 years and speaks with great passion about the system. If you wish to dispose of your sharps inexpensively and in an environmentally responsible way, consider the Medical Waste Machine!
Amy Baxter MD is one smart pediatrician. She was originally trained as an emergency room pediatrician, and now she’s a successful inventor and entrepreneur. In residency and fellowship, she was interested in the management of “pain and suffering” and her research involved using topical medications to reduce pain associated with lumbar puncture. As she relates in the videos (Part 1 and Part 2), she was driving home following an ER shift one night, traveling along a bumpy road. The vibrations transmitted to the steering wheel made her hands go numb, and she serendipitously realized that vibration could be used to reduce the pain associated with needle sticks. She also discovered that vibration combined with cold was more effective than either modality alone. Over the next 5 years, Dr. Baxter worked with her husband (a pediatric psychiatrist), to develop the Buzzy device that reduces the pain associated with many medical procedures including, but not limited to, IV starts and vaccinations.
Dr. Baxter spent many hours disassembling “personal massagers” (aka “sex toys”) to determine which foreign-made motor could be used for the Buzzy device. She determined that only vibrations of a certain frequency would block pain transmission from peripheral nerves. Years were spent designing and testing the Buzzy, finding a manufacturer and seeking FDA marketing approval. Nearly five years after her “Eureka” moment described above ,on May 1, 2009, the Buzzy was released. Now almost 12 years later, Dr. Baxter’s company, Pain Care Labs, has sold more than 250,000 Buzzys globally, and over 35 million shots have been given using the device.
No small achievement
Providers are sensitive to the needs of children who undergo injections and painful procedures. It takes a caring and patient provider to make a child’s experience in a physician office or surgical suite a positive one. Many children who receive 4 or more vaccinations at a well child visit become needle phobic. As a consequence, many well visits (especially those involving vaccinations) are distressing experiences for child, parent and provider. Many adults have needle phobia as well.
The Buzzy changes all this. I use it regularly in my pediatric practice and you should consider using it in patients of all ages. There are several Buzzy devices that range in price from $44.95 to $99.95 dollars. These differ in features, with some intended for home use and others for use in a healthcare environment (see https://buzzyhelps.com/pages/compare). A reusable cold pack is attached to the Buzzy, the vibrations turned on by flipping a switch, and the unit is placed proximal to the IV start location while the needle/catheter is inserted. For subcutaneous injections the Buzzy is placed over the site of the injection for 30 seconds to 2 minutes (depending on the medication being administered), moved proximally, and the injection given at the site where the Buzzy was originally located. There are many subtleties regarding using the Buzzy which Dr. Baxter details in the second video. For optimal use one needs to understand the innervation of the body area where the procedure or injection will occur. One can also use distraction techniques (also detailed in the video) to reduce the “fear” component of needle phobia.
More recently, Dr. Baxter introduced a device based on her previous discoveries. Pain Care Labs is marketing the Buzzy VibraCool Massaging Ice Therapy System for use by individuals with neck, shoulder, wrist, and knee pain. The system combines a Buzzy device with a Neoprene compression strap to achieve effective pain relief while treating inflammation. In one study, VibraCool was shown to be four times as effective as transcutaneous electrical nerve stimulation (TENS) for back and shoulder pain, and twice as effective for osteoarthritis. A study on opioid use following anterior cruciate ligament reconstruction (ACLR) found patients using VibraCool had a 35 percent reduction in post-operative opioid medication use.
Undoubtedly, Dr. Baxter will continue to innovate and develop new products that will facilitate medical procedures and reduce the pain associated with arthritis and injuries. When she does, I’ll be among the first to review these devices and share my impressions with the visitors to Medgizmos.