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!
I’ve long been a fan of the pulse oximeters produced by Masimo (Irvine, California). Please see my article from Contemporary Pediatrics October 2014, Pulse oximetry: The fifth vital sign, for a discussion of the history of pulse oximetry, review of the technology, and tips for using pulse oximeters.
An oximetry sensor consists of red and infrared light emitting diodes and a photodetector placed on opposite sides of a measurement site, usually the finger in adults and children but the palm or foot in neonates and toddlers. The ratio of red to infrared light that passes through the tissue depends on the percentage of oxygenated versus deoxygenated hemoglobin in the arterial circulation of the tissue. In turn, the percentage of oxygen saturation displayed by a pulse oximeter is determined by an algorithm in the microprocessor of the device based on saturation measurements obtained by sampling a large population of patients breathing mixtures of decreased oxygen concentrations. These algorithms are unique for each manufacturer. Pulse oximeters take hundreds of readings over a 3- to 6-second time period and update their measurements every 0.5 to 1 second. In the best of circumstances, pulse oximeter readings come within 2% to 3% of those produced by co-oximetry, the measurement of arterial blood directly by a blood gas analyzer.
When using oxygen saturation clinically, it is important to recall the oxygen dissociation curve we learned in medical school . The upper “bend” in the oxygen dissociation curve occurs at a pO2 of 60 mm Hg of oxygen, which corresponds to an oxygen saturation of 90%. Therefore, one needs to be aware that saturation levels of 90% and below are associated with hypoxemia.
Masimo uses a proprietary technology called “signal extraction technology” (SET), which provides rapid signal acquisition and signal stability even when used in the “wiggly’ patients pediatricians deal with every day. I have been using the Masimo Rad-G pulse oximeter for some time. It features a touch screen interface, is very durable, and provides readings of pulse oximetry, wave form, perfusion index, as well as a respiration rate from a photoplethysmogram. Best of all there is a new pediatric sensor that is now available for children 10 kg and above which makes it easy to obtain reading in young patients.
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……
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.
I continue to be amazed by how versatile smart phones have become and how innovative companies continue to add to our repertoire of “connected” healthcare devices. Such is the case of the D-EYE Portable Retinal Imaging System. Many primary care physicians would benefit from a better way to visualize the retina and optic disc. Our traditional ophthalmoscopes, after all – provide only a limited view of the retina, even when used with the most cooperative patients. The D-EYE system uses the sophisticated optics of the camera built into many iPhone models in combination with a special attachable lens to provide clinicians with an improved view of the retina. We need to visualize the retina during routine examination and in situations where we follow patients for diabetes or hypertension, and in any patient young or old presenting with headaches, or a history of head trauma.
The iPhone is fitted with a bracket that facilitates magnetic attachment of the D-EYE system (see video). Officially priced at $500, I’ve seen the system priced as low as $400. A little bit of training is required to become proficient with the system. Once you learn the application interface and become facile with the device, you will be rewarded with a better view of the retina.
I love tech that is simple, affordable and improves medical practice. Such is the case for the Optivisor which is a $40 to $50 purchase from Staples, or Amazon, or EBay!. It is a visor/headband combination that enables you to see those things you need to see with an increased magnification. I use it for suturing, removing sutures, freezing warts, removing ticks,, removing splinters, or just getting a better look at suspicious nevi.
You can adjust the headband to fit securely. Battery powered headlamps are available as well. If you wear glasses as I do it is an easy matter to position the visor over your head while wearing glasses so I can visualize what I want to see with and without magnification – I just flip the visor down when I want to use it.
Also the visor can be fitted with lenses of different magnifications, depending you the need and your personal preference. Great product and one every primary care physician should consider placing in every exam room!
Pulse oximetry is recognized as the fifth vital sign – together with temperature, respirations, pulse, temperature and blood pressure, it is routinely obtained at most medical visits. While many stand alone pulse oximeters cost upwards of $1000 or more, there are many lower priced “fingertip” units that can connect via cables or better yet via bluetooth wireless connections to a tablet or smartphone. The Masimo MightySat is a standout that provides accurate readings, shows the pulse, pulse waveform, perfusion index on your smartphone . It features a colored touch screen that will display vertically or horizontally, even when used a finger of either hand. It provides readings in situations of low perfusion or even when a patient is moving or shivering. When the app is loaded on your smart device it finds the MightySat quickly. You can’t beat the price of $300 and available for ios as well as android devices.
Keep in mind that while the device can be used for spot readings, it can also be used for continuously monitoring a patient. The bluetooth connectivity reaches distances of 10 to 15 meters or more. This lets you have a poor man’s remote monitoring system at a fraction of the cost. It communicates through walls, around corners, etc. so it is easy to monitor a patient prior to , during and after a nebulizer treatment or in any situation when monitoring the pulse and/or pulse oximeter readings would be useful.