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 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.
Dr. Rob Sambursky, the President and CEO of Lumos Diagnostics is a very patient man. His brainchild, the FebriDx point of care system, can help providers distinguish between febrile respiratory infections caused by viruses from those caused by bacteria. It is presently in use in Canada, Europe, Pakistan, Singapore, and Australia, and currently in clinical trials for approval by the Food and Drug Administration for release in the United States. As Dr. Sambursky discusses in the video, the COVID-19 pandemic, has slowed enrollment in the clinical trials.
In the video Dr. Sambursky discusses the development of the FebriDx system, a journey that began, over 10 years ago. He is a ophthalmologist with additional training in infectious disease. He initially developed a product that could rapidly detect pathogens responsible for eye infections. This then led to an association with other researchers and eventually his interest in developing a rapid assay for Myxovirus resistance protein A (MxA), an interferon-induced dynamin-like GTPase , which is elevated in febrile respiratory infections.
The FebriDx test takes is completed in just 10 minutes, and is inexpensive (about $15). A finger is prepped with an alcohol wipe and dried, the lancet built into the device is activated and applied to the fingertip. A plastic tube draws up 5 microliters of finger stick blood which is then transferred to the cartridge mechanism. A button is pressed, releasing agents and a few minutes later, the device indicates whether the patient has elevated Myxovirus resistance protein A and/or CRP. An elevated CRP indicates bacterial respiratory infection, while an elevated Myxovirus resistance protein A with or without CRP indicated viral infection.
Dr. Sambursky discusses a variety of fascinating topics in the interview. First and foremost, when point of care PCR tests for identifying COVID-19 infected individuals are in short supply the FebriDX test may help identify those patients who should be prioritized for testing. Myxovirus resistance protein A is elevated in non-novel coronavirus infections, and one would expect that it would be elevated in patients infected with the novel coronavirus. Obviously Lumos Diagnostics will need to demonstrate to the satisfaction of the FDA that Myxovirus resistance protein A is elevated in COVID-19 infections. Once this has been established in a large cohort of patients, the FDA should consider fast tracking its release in the USA.
Pediatricians in the United States are already familiar with the CRP test and its utility in facilitating clinical decisions, but to date there are no Clia’88 waived POC CRP tests available. I can think of many potential scenarios where the FebriDx can be helpful – the child who is well appearing and has diffuse rales on lung exam, the crying child who has suspiciously red ears, the well appearing child with a mild sore throat who tests positive for strep and may be a carrier. We will need to wait until the device is available to decide on its usefulness in clinical practice.
Over the next few months you will have the opportunity to read my article in Contemporary Pediatrics, that details a “Battle Plan for Combating COVID-19”. One of the topics discussed is the importance of selecting the best Telehealth (TH) application/platform for your practice. For many physicians and associate providers this is now a “no-brainer” as the Doximity Dialer Video application for IOS and Android smartphones was just released. Not only is the application (a sub-application within the Doximity application itself) free of charge, it is probably the easiest to use of all the TH applications I have used. Doximity provides a Business Associates Agreement to users, which permits practices to use the Doximity Dialer application as an official HIPAA compliant TH platform for their practice.
As Dr. Peter Alperin, Doximity’s Vice President, Product says in the video, “The application just works!” The application masks the phone number of your smartphone and presents the patient with a phone ID which presents the Practice name and phone number, so the patient will never view your private number. To initiate a video call, you input the phone number, hit the video call button, and a text link is sent via message to the patient. They simply click on the link and the video visit begins. There is no need for the patient to load a web page or download an application.
In the future Dr. Alperin indicates there will be a desktop version of the Doximity Video Dialer as well as a version for Tablets. It’s great that Doximity has fast tracked the release of this essential tool during the COVID-19 pandemic when there has been a rush to integrate TH services into our practices. We have more than enough to worry about. If you trial the Doximity Video Dialer I am confident you will adopt it for your practice – because “it just works!”