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!
Forehead temperatures have been taken by concerned mothers since the dawn of time, and Francesco Pompei, the founder and chief executive officer of Exergen, suspected that the superficial branch of the temporal artery was an ideal site for reliable and reproducible temperature measurement. Exergen introduced its clinical temporal artery thermometer, the TAT-5000, in 2000. Now nearly years later, the company has sold millions of devices and the thermometer is being used by over half of pediatric practices in the United States.
The device measures the patient’s core body temperature, which is about 1°F or 0.5°C higher than oral readings. The TAT-5000 thermometer uses dual scanners, one that measures ambient environmental temperature and another that gauges the arterial temperature of the patient’s skin. The thermometer records over 1000 readings per second, producing an audible click as the device registers a higher reading. After taking 3000 readings, an internal “heat balance” algorithm determines the arterial temperature, which is displayed on the unit’s LED screen. Best of all, although the thermometer lists for over $400, Exergen frequently puts the device on sale for $200. One reason the device is so popular in the medical community is that it carries a lifetime warranty.
Parents also can purchase a home forehead thermometer manufactured by Exergen for less than $30. This is the Exergen consumer TAT-2000C. It uses the same technology as the TAT-5000, but it can store up to 8 temperatures, has an illuminated screen, and can be silenced so it doesn’t wake a child. The device has a warranty of 1 year.
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!
While we continue to battle SARS-CoV-2, it is prudent to continue to sanitize your smartphone, tablets, keys, stethoscopes as well as any PPE that you plan to reuse.
An effective method of sanitizing equipment is via is UV-C sanitation which has been demonstrated to kill bacteria, molds and viruses, including coronavirus in a short period of time.
Single item sanitizers are available as devices that are sold to sanitize cell phones, with sanitization times that can vary from 3 to 15 minutes. These are available from companies like PhoneSoap, Casetify, Totallee, and others. PhoneSoap produces an inexpensive cabinet device called the HomeSoap which sells for an affordable $200 and sanitizes in a 10 minute cycle. It even has a usb-a and usb-c port for charging your smart devices during the sanitization process. At this price a practice can easily afford placing the HomeSoap devices throughout the office.
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.
New Welch Allyn Diagnostic Tools – 2021Update: Interview and Review
The (new) tools of the trade….
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……