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 use numerous forms to screen children for depression, anxiety, suicidal risk, substance abuse, ADHD and other. These forms are also used to monitor patients undergoing treatment.
I recently interviewed David Kraus PhD, President, and Chief Scientific Officer of Outcome Referrals, who developed the Treatment Outcome Package (TOP), to screen adults, adolescents and children for a wide range of symptom and functional domains. The TOP consists of a 58-question questionnaire for adults and adolescents and 48 -question questionnaire for children that can be filled out in minutes. It is used to establish a diagnosis and to monitor a patient’s improvement during and following treatment.
Dr. Kraus has demonstrated that the TOP system can be used to identify therapists who are most appropriate to meet a patient’s individual needs. This has been validated via several studies available on the outcome referral web site.
The interview is wide ranging and very informative. The TOP can be filled out via paper forms or via an online portal and repeated as indicated. What I find most exciting is that Dr. Kraus is developing a system, called “FastPass” to facilitate access to appropriate therapists. As we are all aware patients now often must wait months to see a therapist, and hopefully the FastPass system, once implemented will shorten wait times considerably. Stay tuned
Most pediatricians are aware that plagiocephaly (asymmetric head shape), and brachycephaly (wide head shape), occur frequently in young infants, with some estimates placing the incidence as high as 19 to 40%. Plagiocephaly and brachycephaly occurs from there is prolonged pressure on the skull before or after birth and is more easily corrected before ossification begins at 5 to 6 months of age. Congenital muscular torticollis, resulting from shortening of the sternocleidomastoid muscle unilaterally can contribute to the development of these conditions. Plagiocephaly and brachycephaly, if not diagnosed and left untreated place an infant at risk for facial asymmetry, mandibular asymmetry, asymmetric motor skills, and increased risk of development delay. They are also associated with increased risk of in utero positional deformities such as clubfoot and developmental hip dysplasia.
Treatment of brachycephaly and plagiocephaly with or without congenital muscular torticollis involves range of motion and positional therapy. Often affected children who are diagnosed late or do not improve are then referred for physical therapy. If diagnosed after 5-6 months of age or when other therapies do not produce adequate improvement, helmet therapy is then indicated.
It is estimated that only a fraction of the babies born each year with plagiocephaly and or brachycephaly are treated, leaving the remainder undiagnosed and never treated.
Two scientist parents whose child was diagnosed with plagiocephaly, thought there should be a better way to screen for these conditions as well and monitor improvement with therapy. They joined with other scientists to investigate the possibility of making a mobile application to facilitate the diagnoses and monitor therapy. The company, PediaMetrix was formed in 2018, and now after years of research and development they now have FDA approval to market their prescription based mobile application called SoftSpot.
Neurosurgery and craniofacial centers employ hand calipers to measure the cranial index. The oblique diagonal difference is a measurement of the asymmetry of the skull. These measurements quantify the severity of the problem and are used to determine if the infant would benefit from positional and range of motion therapy, physical therapy, or helmet therapy.
The SoftSpot application is available on android and ios platforms. A cap is placed on the infant’s head to prevent artifacts due to the baby’s hairline, a sticker placed on the top of the head and a short video taken via the SoftSpot application. This is then upload to the PediaMetrix site where AI based algorithms are used to compute cranial measurements. A report is sent to the pediatrician who can discuss this with parents and make recommendations. Measurements are taken monthly for those infants who are being observed, or who are receiving therapy, and a progress report sent to the pediatrician.
The application is easy to use and is expected to be very affordable. PediaMetrix has recently received an NIH grant to develop a mobile application that may be able to identify infants at risk for craniosynostosis.
I think the application lends itself to Telehealth visits, and can help identify the many babies with plagiocephaly or brachycephaly that go undiagnosed and untreated. Stay tuned!
In 2001, 2 developmental pediatricians, Drs. Barbara Howard and Raymond Sturner, developed the Child Health and Development Interactive System (CHADIS; Total Child Health Inc; Baltimore, Maryland), a comprehensive web-based system for screening children for behavioral and developmental problems. The CHADIS online portal has received 26 million dollars in federal and foundation grants for research and development of the current system. To date, more than 5000 providers from around the globe are using the CHADIS system, and it continues to grow in features and popularity. The CHADIS assessment tool allows pediatricians to invite parents to fill out online, age-appropriate screening tools in advance of well-child visits. The CHADIS system evaluates the forms filled out by parents, performs scoring when indicated, and alerts pediatricians of issues that need to be discussed with parents at well-child or behavior-related visits. Many pediatricians speak favorably of the CHADIS system in that it allows them to identify parental concerns and behavior issues that would have gone unidentified in the past. A CHADIS subscription costs about $1500 per provider per year, paid either annually or via monthly installments with discounts available for volume licenses.
As of this writing, CHADIS incorporates more than 200 screening tools that pediatricians utilize frequently, such as the Modified Checklist for Autism in Toddlers Revised with Follow-up (MCHAT R/F), Ages and Stages (ASQ), Vanderbilt Assessment Scales, Patient Health Questionnaire for Adolescents (PHQ-9), and Generalized Anxiety Disorder (GAD-7) forms, as well as forms. However, CHADIS doesn’t stop at screening. It also provides a full library of resources for pediatricians and parents to assist in management once a condition is diagnosed. Another benefit of CHADIS is that Dr. Howard conducts a case webinar on a monthly basis to discuss issues related to developmental screening and management.
The CHADIS screenings can be used by parents via their home computers in advance of visits or alternatively via a tablet-based interface that is handed to them at the reception window. The CHADIS reports can be copied and pasted into your EHR so that the results of the screening are documented.
Pediatricians typically screen adolescents for scoliosis at preventive health visits. Usually we screen visually and obtain a screening scoliosis x-ray series if we suspect significant curvature. One can use the Scoliometer application from Dr. Kevin Lau/Health in Your Hands to screen patients with any mobile device. The inclinometer built into the device facilitate this. One places the mobile device on the child’s spine at the area of greatest curvature and records the Angle of Trunk Rotation (ATR) displayed. Patients with ATRs of 5 degrees or higher should be referred to orthopedics for further evaluation. An ATR of 7 degrees corresponds to a radiographic Cobb angle of 20 degrees, which indicates mild scoliosis.
The application is just $4.99 for IOS and $4.49 for Android devices, and includes a built in video guide and recommendations for its use. Dr. Lau recently released the $4.99 ScolioTrack application to facilitate parents monitoring their child’s scoliosis.
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.
I’ve been using Dragon Medical for years and each iteration improves on the previous version. Nuance recently released Dragon Medical One and it is truly wonderful. No longer do you need to “train” the software. With your first use – the accuracy is terrific. This version is server based and users install an application on their smartphone to enable the phone to function as a wireless, network connected smart microphone.
The application enables users to assign commands to different “buttons” so you can choose to move from one field to another, activate voice macros that insert templates or move to different areas of the EHR.
One can dictate twice or three times the speed at which one types. This means than once you become facile with Dragon Medical One – you complete your notes much faster than you can by typing. This means that you can complete notes before the end of the workday. No longer will you need to take work home with you. The need for completing notes at home is a major cause of provider “burnout”.
It is worth your time to not only to become skilled in dictating notes, but to take the time and effort to develop macro voice commands that insert phrases, templates, or navigate within the EHR or within the operating system. You should read the manual (of course) which will quickly educate you how to delete or replace phrases, correct words or add words to your vocabulary. Outstanding!