For patients who need care in rural areas, getting diagnostic tests can be a complicated process. In some cases, individuals may need to travel long distances to larger facilities to access needed technology.
To solve these problems, many developers have focused their innovation efforts on point-of-care ultrasound devices, or POCUS.
As Dr Mark Favot explained to Health Informatics Newsthese tools – especially portable ones – can help make care more widely available and less expensive in remote areas.
Favot, an associate professor and director of EM Ultrasound Education at Wayne State University School of Medicine in Detroit, talked to us about how artificial intelligence guidance can make a difference with POCUS, and shared what makes it so. longer-term passion about technology.
Q. Why does access to point-of-care ultrasound devices make a difference to patient care, especially in rural areas?
A. Health care in rural areas often involves patients seeking medical care in facilities that are not equipped with the full range of diagnostic testing resources like large medical centers in urban centers. Often, the doctor looking after the patient has to arrange transfer to larger hospitals so that the patient has access to things like CT scans, magnetic resonance imaging, and echocardiography.
Providing high-quality healthcare in an environment lacking these resources can be challenging for doctors and frustrating for patients.
Delays in diagnostic testing (either because the patient is transferred to another facility or because urgent tests are postponed to a later date in an outpatient setting) not only add to the frustrations felt by both physicians and patients, but are often associated with adverse effects. disease-related outcomes that prompted the patient to seek rural care in the first place.
Traditional ultrasound imaging that occurs in a suite in the radiology department is usually available during the day, but may have limitations as to what parts of the body it can scan.
With the advent of point-of-care ultrasound, or POCUS, the imaging paradigm has moved away from the traditional model of images acquired by a trained sonographer and then sent to a radiologist for interpretation to a model where the treating physician of the patient is to perform and interpret the POCUS in real time while developing a treatment plan for the patient.
Larger portable cart-based POCUS machines have been around in emergency departments for 20 years, but they are often quite expensive – and in a low-volume healthcare setting, such as a rural emergency department, they may not not be a financially viable solution if they are not used often enough.
POCUS portable devices have further changed the imaging paradigm because they are often affordable enough to belong to physicians (rather than hospitals) and can be taken to any healthcare facility where that physician works. This development has significant implications for patients in rural health care settings, as often the physicians who work in these hospitals do not live in the community where the hospital is located. If the hospital does not have cart-based POCUS equipment, the physician can bring their own portable POCUS device to the hospital for their clinical shifts in the emergency department.
Armed with this technology, doctors can now use POCUS to facilitate diagnostic testing for patients, which can improve the ability to rule out or rule out specific diagnoses for patients, rather than being forced to transfer them to centers where they could meet. having completely normal imaging, only to be sent home from a hospital 60 miles from their home.
Q. How can AI guidance make a difference with these devices?
A. Artificial intelligence has the potential to dramatically increase the effectiveness of POCUS, primarily by reducing the impact of poor image interpretation confidence, which is one of the most common barriers to implementation. from POCUS.
Many physicians have learned about POCUS by taking one or two-day continuing medical education courses taught by a large group of POCUS experts. These courses offer many benefits to participants, including favorable faculty-learner ratios, a wide variety of high-end POCUS equipment, simulated patient models with excellent “windows” for ultrasound imaging, and access at conferences. with a wide range of pathologies.
The “problem” for people taking these courses starts when they return to their own facility and now have to scan with their older and often outdated equipment, on patients who may have issues that make ultrasound imaging difficult and without the expert next door. guiding them on probe movements to improve images or helping them with interpretation when things don’t look exactly like the textbook or lectures they’ve recently attended.
Typically, if the doctor works at a facility with a robust POCUS program, that ultrasound exam will be reviewed by a POCUS expert one to three days later, and if there were any issues with the exam, this expert will be able to offer them comments and suggestions for improvement. While this feedback may help this physician the next time they use POCUS, it will not help the patient they have just scanned, and the impact of feedback provided after the fact, not in real time, is limited. .
AI can be that important bridge between expert feedback days later and no feedback at review time. Robust AI on POCUS machines can give the user immediate feedback to improve the image, such as “Tilt the probe towards the patient’s head to acquire the correct apical 4-chamber image of the heart which includes at the both atria and both ventricles”, rather than the image the user had acquired which only had the right and left ventricle.
This type of AI feedback has clear immediate benefits for patient care now that a proper diagnosis can be made, as the physician has been able to acquire a more easily interpretable standard POCUS image. However, the long-term impact of immediate AI feedback could be even more impactful.
Often physicians will be enthusiastic about using POCUS in their practice immediately after completing the training, but over time this enthusiasm wanes because their confidence levels also begin to wane the further they go. of the training session. When AI is integrated into POCUS systems, it can take on the role of an expert POCUS practitioner standing at the bedside. However, since it’s a machine and not a human at your side, it creates a low-pressure environment that makes it easier for the new POCUS user to use the machine and gradually improve their skills at the over time. POCUS is very humble for doctors, and the shame of not being strong in this skill can lead doctors to avoid using it. AI is one way to overcome this.
Q. What excites you about the potential of POCUS in the short and long term?
A. I am very excited about what is happening at the medical school level regarding the demand for POCUS. Today’s medical students are very tech-savvy, and they won’t sit idly by and accept that 200-plus-year-old technology like a stethoscope is the most effective diagnostic tool for their patients. They have and will continue to demand more from their education.
Institutions with strong POCUS curricula for medical students, such as the Medical University of South Carolina, Wayne State University and University of California-Irvine, have seen an increase in applications as prospective students seek POCUS training. Schools that don’t currently have a POCUS program are scrambling to catch up.
Students drive change from the bottom up and force leaders to respond. The earlier physicians gain access to POCUS training in their careers, the more likely these skills will become enduring and stick with them for the long term.
The advent of affordable portable POCUS systems, which are now marketed to physicians rather than healthcare facilities, will help accelerate this change. No matter how effective a POCUS program or educator is, the best learning often happens when a curious doctor picks up a POCUS system and learns by trial and error. When the machine is portable and can be taken home, the doctor, or the doctor’s family, can become the de facto ultrasound model. All of us in the field have had this experience ourselves, and while it may be a slower and more difficult way to learn, it is a proven method that is extremely valuable.
Although POCUS is an important disruptive technology that enables more accurate and faster diagnoses by physicians and enables safer performance of needle-guided procedures, it is important to realize that as the price and availability of the POCUS wearable equipment continues to improve, it is imperative that physicians receive adequate training. Training should ideally start as early as possible in the career, be continuous and targeted to areas of identified gaps, and be aided by modern technologies such as AI.
The explosion of market growth for affordable handheld POCUS has put these machines in the hands of a large number of new physicians, not all of whom have received adequate training. This upward movement demands an appropriate response from healthcare leaders to ensure enough money and resources are dedicated to creating and sustaining programs that train all POCUS users to adequate standards. . By doing so, facilities can be at the forefront of the POCUS wave that has already begun and leverage it to positively impact patients seeking care in a wide variety of destinations.
The ability to bring high quality imaging to any patient, anywhere is the most exciting aspect of POCUS’ future and will be its long term legacy.