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!
Medgizmos.com is proud to introduce our new “sister” site – Medgizmosmarket.com This is an affiliate marketing site that provides discount codes to encourage providers to adopt technologies that will improve care!
The Acoustic Otoscope is back. This inexpensive device quickly determines if there is fluid behind the tympanic membrane. Please click here to see our review and click here to register to receive discount codes toward purchase of the device and disposable tips!
During the course of the day pediatricians and family physicians are called upon to make many decisions regarding patient care of children. What antibiotic and what dose? Is the baby losing too much weight? Rather than using a variety of different application on your smart device, you really need only one. I’ve used Pedi QuikCalc for years and recommend it to all my friends. Probably the best value for those who have iPhones and iPads.
When you launch the app you are prompted to input the weight. You can also estimate future weight based on CDC age based data. Medication dosages are based on this real or estimated weight, as are IV fluid infusion rates. Most helpful is that if you are dealing with a baby or a child with gastroenteritis you can compare two weights to get the percentage change. You can easily convert kilograms to lbs as well. The program doesn’t just have these features, but also a variety of other tools to facilitate care. These include upper limits of blood pressure, growth curves, bilirubin nomograms, etc., etc.
The IV infusion tool is outstanding as it provides infusion rates based on amount of deficit. The bilirubin tool is similarly useful and easy to use with recommendations based on risk factors, baby’s age and bilirubin level. Even the medication lists are outstanding because dosages are based on indication.
Links are also provided to useful sites like the CDC, AAP etc. By the way, in the drug screens you press a button at the top for limiting the display to those drugs used for pediatric advanced life support (PALS).
Kudos to Dr. W. Kent Bonney for developing one of the best apps for those caring for children. Only $1.99 and IOS only. One of the best values as well.
Pediatricians frequently have difficulty arranging mental health services for patients. This is a consequence of an extreme shortage of Child and Adolescent Psychiatrists. According to the American Academy of Child and Adolescent Psychiatry (AACAP) website, the current need for Child and Adolescent Psychiatrists (CAPs) is 30,000 providers, but only 8300 are practicing, and this pool is shrinking. Because of this shortage of child psychiatrists, 75% of all mental health services are provided by pediatricians.
I recently co-authored an article on improving access to mental health services, that will be published in the August 2018 issue of Contemporary Pediatrics. There are several striking statistics that emphasize the need for improving mental health access.
20% of all children in the US have a mental health problem- but only 20% of them receive treatment
13% of children 8-15 years of age have a mental illness that impair daily living- in the 13-18 age group the percentage rises to 21%
50% of lifelong mental illness begins by 14 years of age- 75% by age 24
The average delay between symptom onset and intervention is between 8 and 10 years
So how can pediatricians and family physicians facilitate mental health access for our patients, young and old?
One way of improving access to mental health services is by improving our skill set, by taking courses or being mentored by a dedicated Child and Adolescent Psychiatrist – so we become more proficient in diagnosing and managing patients on our own. Another approach is to embed a psychologist or psychiatrist in your practice.
The quickest and easiest way to facilitate access to mental health services is to consider providing telepsychiatry access in your office! The video describes how this can be accomplished and discusses the E-Psychiatry web site and service. As discussed in the video, E-Psychiatry provides services in all 50 states. Many insurances will pay for telepsychiatry if you access in your office. Self pay patients should expect to pay about $175 per hour for Telepsychiatry visits with a psychiatrist, less for visits with a nurse practitioner.
I recently presented a Technology workshop for 100 pediatricians at the American Academy of Pediatrics (AAP) National Conference in early November. Among a lot of other great tech, we presented SnapMD as part of our brief Telehealth demonstration. All attendees were impressed by the SnapMD platform, and those pediatricians who are considering implementing Telehealth visits would be well advised to consider SnapMD.
In preparation for the workshop I received training from the staff of SnapMD and was truly impressed by the company and the platform. At no charge SnapMD will configure the web-based portals for patients, practice administrators and providers with your practice logo and colors and setup the system to your liking. Some practices may choose to have patients schedule their own Telehealth appointment or schedule an impromptu visit with the on-call pediatrician, while other practices may prefer having the patient call the office with the appointment made by the practice staff.
The video provides a brief overview of the platform. There is a smartphone or tablet based application for patients to use (called Virtual Care), to facilitate scheduling and launching a visit. Patients can also use a web based portal to schedule or launch a visit and enter a “virtual waiting room”. When the physician launches clicks a “start visit” button from inside the portal the visit begins.
I think you will find the company passionate about their product and willing to answer any and all questions.
Mehealth for ADHD is an online tool for diagnosing ADHD in children and monitoring their treatment. I’ve been using Mehealth for ADHD along with my practice colleagues for several years and have been extremely pleased the tool. It facilitates diagnosis of ADHD by having parents and teachers fill out online Vanderbilt forms which are automatically scored. Consequently, evaluations are completed in just a few days. Additionally, it allows pediatricians to monitor a child’s school performance while on medication or receiving behavior therapy- by requesting periodic follow up Vanderbilts from parents and teachers.
The system generates assessment reports and treatment graphs that one can share with parents and integrate into your electronic healthcare record (EHR), and also provides facilitated email communication with parents and teachers. The online tool was developed by the Cincinnati Children’s Hospital Medical Center (CCHMC) in order to improve ADHD screening and management among community pediatricians. A randomized clinical trial showed dramatic improvements in ADHD care among practices using Mehealth for ADHD compared to control practices and a recent study demonstrated that practices treating children with medications who used Mehealth for ADHD had greater ADHD symptom reductions compared to controls.
CCHMC has secured NIH funding to recruit 5000 community pediatricians to adopt the online-tool to study how a variety of factors influence it use and utility. One simply goes to mehealth.com and enrolls. In addition to free access, users benefit by receiving 20 category 4 MOC credit for using tool each year. Mehealth for ADHD recently expanded the tool by integrating online behavior treatments by parents and teachers that enable selection of daily and weekly rewards for achieving behavioral goals.
In the video, above, Dr. Tanya Froehlich, developmental-behavioral pediatrician at Cincinnati Children’s Hospital, presents an update on ADHD and why Mehealth for ADHD can improve the ability of pediatricians to diagnose and treat ADHD.
Every pediatrician is familiar with the Harriet Lane Handbook. Long before the Internet and smart devices were available, pediatric residents were dependent on this “pocket brain” for guidance, and we called upon the wisdom contained within many times each day. It provided valuable information about differential diagnosis, recommendations for workup, and drug dosages, and lots of other information! It was as valuable as our stethoscopes, perhaps even more so, and we were ever so careful as not to misplace our Harriet Lane. It was also filled with scribbles notes we accumulated through our 3 years of residency.
This quote from the preface to the 21st edition of the Handbook details its history:
“The Harriet Lane Handbook was first developed in 1953 after Harrison Spencer (chief resident in 1950–1951) suggested that residents should write a pocket-sized “pearl book.” As recounted by Henry Seidel, the first editor of The Harriet Lane Handbook, “Six of us began without funds and without [the] supervision of our elders, meeting sporadically around a table in the library of the Harriet Lane Home.” The product of their efforts was a concise yet comprehensive handbook that became an indispensable tool for the residents of the Harriet Lane Home. Ultimately, Robert Cooke (department chief, 1956–1974) realized the potential of the handbook, and, with his backing, the fifth edition was published for widespread distribution by Year Book. Since that time, the handbook has been regularly updated and rigorously revised to reflect the most up-to-date information and clinical guidelines available. It has grown from a humble Hopkins resident “pearl book” to become a nationally and internationally respected clinical resource. Now translated into many languages, the handbook is still intended as an easy-to-use manual to help pediatricians provide current and comprehensive pediatric care.”
To this day the Harriet Lane Handbook is an indispensable resource for pediatricians in general practice and hospitalists as well. The hardcopy of the Handbook sells for $50 and one gets free access to the inkling (https://www.inkling.com/read/) presentation of the Harriet Lane content via web site and via the inkling application. Every 3 years a new edition is published, adding new content and updating existing content. The next edition, is due in May of this year.
By the way, there is an “Easter egg” in the Handbook. One of the lab values reported in Harriet Lane does not exist, and this “secret” has been carried forward edition after edition. If you are curious, email me at [email protected] for the answer!
Pediatricians have responded to the COVID-19 by rapidly learning to perform virtual visits for patients. It is not surprising how effective these visits can be for evaluating and treating a wide variety of common medical problems. I’ve been doing Telehealth visits for patients for over 6 years, primarily for patients with ADHD, anxiety and depression. Parents appreciate the convenience of these visits and they require little in the way of nursing preparation. Particularly during the pandemic, virtual visits keep children and parents in their homes, and parents who are working remoting don’t need time away from work.
Not surprisingly there are many conditions which are easily evaluated via virtual visits. These typically include rashes, acne and gastroenteritis. Obviously, one cannot determine whether a febrile child has an ear infection, viral infection, etc. but an experienced provider can determine how “ill” a child appears and whether observation, an emergency room or office visit is required, or a trial of an antibiotic for suspected bacterial infections is appropriate. It is even possible to perform a modified well visit (without the exam and immunizations of course), as parents can acquire inexpensive baby scales and be easily directed how to take a head circumference and length/height measurement.
Anytime Pediatrics is a Telehealth Service that provides for the unique Telehealth needs of pediatricians and their staff. Patient appointments are handled by support staff, and patients can be “virtually roomed” by offices nurses or medical assistants, prior to the start of the visit with the provider. As the video shows – the interface is appealing and easy to navigate.
The service is affordable at $150 per provider per month and there are no extra enrollment costs for administrative and clinical support staff. Although AnyTime Pediatrics began offering the service 3 years ago, the service is now being used by over 1300 pediatric providers. They offer a free demo, so you can determine if their application is the correct match for your practice.