I Think It Is Probably Appropriate To Check Aging Doctors For Fitness To Practice.

This appeared last week:

‘Lacking evidence and probably ageist’: RACGP hits out at medical board’s mandatory health checks for older doctors

'We have serious concerns that this proposed policy is ageist,' says college president Dr Nicole Higgins.

Paul Smith

17 October 2024

The RACGP says the Medical Board of Australia’s push on mandatory health checks for older doctors is backed by no evidence and is probably ageist.

The board wants all doctors aged 70 and over to go through a health assessment at least once every three years as a condition of their registration.

In its consultation paper, it says so-called late-career doctors are 81% more likely to be subject to a complaint than their younger colleagues.

But in a fiery response, college president Dr Nicole Higgins has accused the medical board of failing to show any evidence that mandatory health checks will reduce patient harm or notifications (see box below for the board’s statistics).

“It is unclear [based on the board’s consultation paper] if notifications received by AHPRA were specifically related to the physical or cognitive decline of the doctor, the age of the doctor, and could be avoided by a mandatory health check based on the doctor’s age,” she wrote.

She says that, according to the consultation paper, only 2.58 notifications per 1000 doctors over 70 were for health impairments (0.26%).

“In an inclusive and diverse society, there is no place for ageism, and we have serious concerns that this proposed policy is ageist.”

It is important to “foster a culture that encourages and supports doctors to take good care of their health”, Dr Higgins says.

“Mandatory reporting laws do not help build this culture. Fear of mandatory reporting leads health professionals to avoid getting the help they need.”

She also says the medical board needs to provide information on the medicolegal position of GPs treating older doctors.

“For example, if an assessing doctor has concluded a health professional is fit to practise but AHPRA determines a notification or suspension is required.”

The board’s consultation paper, released two months ago, suggests GPs are only expected to make a notification if the doctor refuses to deal with a health impairment and there is a serious risk of patient harm.

It says it does not want to see the results of any assessment.

However, it expects late-career doctors to declare in their annual registration renewal that they have completed the appropriate health check, including, as now, any declaration that they have an impairment that “detrimentally affects, or is likely to detrimentally affect, their capacity to practise medicine”.

One key element of the board’s plan is that the health assessments conducted by an older doctor’s GP should include cognitive screening.

It acknowledges that the Mini-Mental State Examination commonly used by GPs is flawed.

But it suggests the adoption of either the Montreal Cognitive Assessment or the Addenbrooke’s Cognitive Examination, saying both have “very good sensitivity in detecting mild cognitive impairment”.

The college says any demands for health checks should be evidence based and consistent with the college’s Red Book.

“The Red Book does not recommend screening for dementia in the general population.

“A case-finding approach to dementia is recommended, being alert to risk factors, signs and symptoms of dementia with the best time to identify dementia risk factors earlier in life.”

The college’s stance on mandatory health checks contrasts with the position of the AMA, which says it does not support retaining the status quo in its own submission.

While the AMA’s submission does not explain what system it does want, it stresses there should be no requirement for older doctors to undergo cognitive screening.

“A better model would not include specific cognitive function screening in the health check, but it would make it clear in resources for GPs that they should consider cognition and use their clinical judgement regarding screening and/or write a referral for formal assessment if required,” its submission states.

The medical board’s statistical breakdown on the risk of older doctors In 2023, there were 6975 practising doctors aged 70 and over, including 1035 aged 80 and over. The board’s consultation paper says those aged 70 and over are 81% more likely to be the subject of a complaint than their younger colleagues. It refers in particular to the differences in the rates of complaints about clinical care (15.9 per 1000 doctors under 70 vs 24.2 per 1000 late-career doctors), communication (4.7 vs 11.3) and pharmacy and medication (4.6 vs 12.2). It needs to be stressed that one doctor may be generating more than one notification. In absolute numbers, older doctors last year generated 168 notifications relating to clinical care, 78 relating to communication and 85 relating to pharmacy and medications. There is no detail on the extent to which these notifications are linked to health impairments. The board’s paper stresses that, in terms of overall notifications, 23% of the complaints against late-career doctors resulted in some from of regulatory action — in the vast majority of cases, the imposition of conditions or cautions. The consultation paper says this compares with 14% of the notification against younger doctors. Source: Health checks for late-career doctors impact statement; 7 Aug 2024.

More information:

• Health checks for late-career doctors impact statement; 7 Aug 2024.
• AHPRA news; 7 Aug 2024.

Here is the link:

https://www.ausdoc.com.au/news/lacking-evidence-and-probably-ageist-racgp-hits-out-at-medical-boards-mandatory-health-checks-for-older-doctors/

I have to say I am on the Medical Board’s side here. Anyone over 70 or so should be able to demonstrate they are still cognitively intact, Just how you do this is the trick I reckon – but just like with pilots etc. we need to protect the public against failing cognition!

What do you think?

David.

The Government Really, Really Wants You To See Your Clinical Results – Even If You Have No Idea What They Mean!

These appeared during the week:

Govt pushes ahead with real-time pathology data sharing plan

---

Brandon How
Reporter

17 October 2024

New laws that will force health providers to upload pathology and diagnostic imaging to My Health Record by default or forgo Medicare payments will be introduced to Parliament next month.

In a speech on Thursday, Health minister Mark Butler said “near real-time access will be the new standard” on My Health Record, confirming the government will remove the rule that patients must wait seven days before being given access to their imaging reports.

However, “in some cases a clinically appropriate delay may remain if appropriate”, which will go some way to appeasing medical professional associations, which have argued a blanket change to the rule would create misinformation and stress out patients.

The government had initially hoped default sharing of pathology and diagnostic imaging reports would be implemented from June 30, 2024 but is now targeting mid-2025.

Mr Butler announced the proposed changes in May 2023 and consultations took place between September and October 2023. Last year’s federal Budget earmarked $13 million over two-years for work on the ‘share by default’ framework.

The seven-day delay on granting patients access to pathology results was introduced in 2014 to give follow up healthcare providers sufficient time to review results and discuss them with patients before the reports are available on My Health Record.

However, as at the start of this year, the delay has been removed for a handful of tests including COVID-19 and 13 other respiratory pathogens.

While the ‘sharing by default’ framework has yet to be finalised, Mr Butler said that pathology and diagnostic imaging companies that don’t upload the data to My Health Record “will not get a Medicare benefit for that test or scan”.

“Before agreeing an approach, I will consider advice from the Clinical Reference Group, co-chaired by former AMA President Dr Steve Hambleton and Conjoint Associate Professor Carolyn Hullick, the Chief Medical Officer at the Commission on Safety and Quality in Health,” Mr Butler told the Victorian Healthcare Week conference.

The Australian Medical Association is among the professional groups opposed to a blanket removal of the seven-day delay for patient access to pathology and diagnostic imaging reports, although they have not raised concerns regarding mandatory uploads.

Since announcing plans to implement ‘sharing by deafult’, the number of diagnostic imaging reports uploaded to My Health Record has increased from one in five to one in three.

Now, more than 10 million pathology and nearly one million diagnostic imaging reports are uploaded monthly.

“While this is an improvement, it is still too low and too slow,” Mr Butler said.

All state and territory governments are sharing pathology and diagnostic imaging reports, “with most uploading more than 75 per cent of all tests and scans, and most on track to share 100 per cent of them in coming months”.

The number of private radiology clinics connected to My Health Record has doubled, with Australia’s largest private radiology providers among those that have pre-emptively made the switch to default sharing of reports with the My Health Record.

“Australia’s largest private radiology provider, I-MED has started sharing by default from all their Western Sydney clinics,” Mr Butler said.

“In the ACT and southern New South Wales, Capital Pathology is sharing by default from every one of their clinics. The third largest private radiology provider, Lumus, is the first to share by default nationally.”

Mr Butler also confirmed that the CSIRO-led Sparked consortium – which has led recent work to develop a national set of data and exchange standards – has turned its attention to digitising “Chronic Condition Management Plans, capture the reason a patient presents for healthcare, and develop the additional data-sharing attributes”.

The Department of Health and Aged Care is also looking working on a framework for rolling out electronic medication charts beyond the aged care sector, which has seen 80 per cent uptake, according to Mr Butler.

Here is the link:

https://www.innovationaus.com/govt-pushes-ahead-with-real-time-pathology-data-sharing-plan

Also we have

Butler hopes to introduce ‘sharing by default’ laws next month, warns penalties may apply

17 October 2024

By Kate McDonald

The Australian government will introduce legislation to Parliament next month to support its ‘sharing by default’ policy, which will mandate the sharing of key health information with consumers starting with pathology and diagnostic imaging report uploads to their My Health Record.

Health Minister Mark Butler told the Victorian Healthcare Week conference today that penalties may apply to healthcare providers that refuse to upload results, which will see them lose out on Medicare benefits.

The mandate to share pathology and imaging reports in near real time is expected to see the elimination of the seven-day rule for test result uploads to My Health Record, although this element is still up for consultation.

It will be followed by other mandates on sharing information such as medication events, prescriptions, dispense records, and the administration of medicines in care settings.

Mr Butler said the government’s investments in digital health, along with a collaborative engagement with clinicians and software providers, were driving an upgrade to My Health Record that will improve patient care and shift provider behaviour.

He said that My Health Record was in “dire need” of an upgrade when his government was elected in May 2022.

“It was still using the old PDF format that Labor installed when we were last in government,” Mr Butler said. “It was cutting edge then, but it is beyond clunky now. For almost 10 years, nothing was done to upgrade the technology that underpinned it.

$1.1 billion in new funding was announced in the May 2023 federal budget to modernise the digital health infrastructure and upgrade My Health Record to a data rich platform, he said.

“A bit over one year on, and Australia is seeing the most substantial digital health reforms in more than a decade, across three major areas: standards, medicines, tests and scans.”

He listed the development of the Sparked initiative, led by the CSIRO, to deliver a national set of data and exchange standards based on FHIR.

“The first goal was to develop standards for core patient health information covering procedures, allergies, medicines, problems, immunisations and results,” he said. “In just 10 months, that goal was achieved.

“In June this year, Australia’s first ever national information sharing standard was published and can now be built into clinical systems.

This represents more progress in 10 months than in all of the previous 10 years, combined.”

The Sparked accelerator is now looking at how to digitise chronic disease management plans, “capture the reason a patient presents for healthcare, and develop the additional data-sharing attributes needed for a national patient summary record”, he said.

Work has also been done on medicines, including the transition to a single national delivery service for prescriptions, along with the expansion of electronic prescriptions from GPs and the community into public hospitals.

He also mentioned the roll out of electronic medication charts to aged care, where nearly 80 per cent of facilities have received a grant to adopt them.

But he said perhaps the biggest revolution underway in digital health is in the availability of scans and tests in My Health Record.

“All states and territories are now sharing pathology and diagnostic imaging reports to My Health Record, with most uploading more than 75 per cent of all tests and scans, and most on track to share 100 per cent of them in coming months,” he said.

“By the end of the year, for the first time, client support plans will be able to be shared from My Aged Care to My Health Record.

“Patients expect their diagnostic scans and pathology tests to be uploaded. This only happens by exception. It is not the rule.”

The government now plans to make it the rule, he said. “Over 10 million pathology and nearly one million diagnostic imaging reports are being uploaded each month.

“In May last year, just one in five diagnostic imaging reports were being sent to My Health Record. A year later, and one in three reports are now being uploaded.

“While this is an improvement, it is still too low and too slow, which is why I will soon introduce legislation that will mandate sharing by default for all tests and scans in near real-time.

“To enable faster access, I am looking to remove the seven-day delay that prevents patients from seeing their results sooner. While near real-time access will be the new standard, in some cases a clinically appropriate delay may remain if appropriate.”

A clinical reference group, co-chaired by former AMA president Steve Hambleton and chief medical officer at the Commission on Safety and Quality in HealthCare, Carolyn Hullick.

Mr Butler was particularly critical of an unexplained decision by pathology provider Healius to cease uploading reports to My Health Record last September – which he said meant an estimated 10 million test results were missing from My Health Record and would never be able to be uploaded – although the company has since resumed uploads.

“Test results and scans belong to patients, not providers, and they need to be shared to a patients’ My Health Record,” he said.

“To show that we’re serious, the laws will include consequences for companies that do not share.”

This will include a withholding of a Medicare payment if the patient’s results are withheld, he said, as the “sharing by default framework will ensure that pathology and diagnostic imaging companies that do not upload the results of a test or scan will not get a Medicare benefit for that test or scan”.

“Withhold a patient’s results and we will withhold the Medicare payment.”

Mr Butler said this would benefit healthcare providers as it would reduce spending on needless or duplicate tests or scans, along with productivity benefits.

“Every minute a GP doesn’t spend searching through My Health Record for a result that may or may not be stuffed into the PDF shoebox, is a minute they can spend with a patient,” he said.

“Every minute a practice nurse doesn’t have to spend manually entering a patient’s data into their My Health Record, is a minute that they could be administering a childhood vaccination.

“Every minute a practice manager isn’t held up on a phone call with a patient chasing up their results, is a minute that another patient doesn’t have to wait on hold to make an appointment.”

He said the “sharing by default” legislation will be introduced to Parliament next month, and he’d like the laws to be passed and in place by the middle of next year.

Here is the link:

https://www.pulseit.news/australian-digital-health/butler-to-introduce-sharing-by-default-next-month-warns-penalties-may-apply/

And we have:

17 October 2024

‘No rebate for you’: Butler threatens path labs if they don’t upload results

By

Laura Woodrow

The health minister announced he would withhold pathology companies’ Medicare rebates if they don’t upload patients’ results to the electronic health record.

The federal government will withhold Medicare rebates from pathology services that do not comply with legislation for mandatory My Health Record uploading, says health minister Mark Butler. 

Last year, Mr Butler announced plans to implement mandatory uploading of pathology and diagnostic imaging reports to MHR and to void the seven-day delay on report availability for patients. 

Opening day two of Victorian Healthcare Week’s digital healthcare convention in Melbourne this morning, Mr Butler said laws to be introduced next month would include consequences for companies which did not comply. 

“The sharing by default framework will ensure that pathology and diagnostic imaging companies that do not upload the results of a test or scan will not get a Medicare benefit for that test or scan,” he told delegates. 

“It’s that simple. Withhold a patient’s results and we will withhold the Medicare payment.  

“It’s not a drastic position for a government to take.  

“In the United States, for example, the 21st Century Cures Act requires the portability of health records with open access to consumers to their own health information.  

“Under that legislation, providers that do not have modern, cloud-based systems in place to enable this sharing can be sent to jail, which is not something we’re considering.” 

Mr Butler acknowledged a heckle of “yet” from the audience.  

“Our health systems are obviously different to America’s,” he said. 

“[But] since the US laws were introduced eight years ago, study after study has shown a range of benefits to consumers and health providers after the removal of delays to patients viewing their own results.” 

The Department of Health and Aged Care did not respond to The Medical Republic’s request for information on how the legislation would affect rebates to patients for non-bulk-billed services. 

While near real-time access would be “the new standard”, Mr Butler said he would consult with the Clinical Reference Group about “clinically appropriate” cases where the delay may remain. 

By the end of the year, client support plans will be able to be shared between My Aged Care and My Health Record, added Mr Butler. 

Since the announcement of the plans last year, all states and territories were now sharing imaging reports to MHR, with most uploading over 75% and “on track” to share 100% in the coming months, he said. 

“Since [the] announcement … the number of private radiology clinics connected to MHR has more than doubled.” 

While the needle is shifting, progress remains “still far too low and far too slow”, said Mr Butler. 

“It’s clear that we cannot leave patients to rely on the benevolence of private providers,” he said. 

Healius – Australia’s second largest private pathology provider, which received almost a billion dollars in Medicare benefits in the 2022/23 financial year – was named and shamed. 

“In August of that year, Healius was uploading over 800,000 pathology reports a week to MHR,” said Mr Butler. 

“No sooner had we released [the] proposal for public consultation, that very same day, Healius wrote to DoHAC to say that it would imminently suspend the upload of pathology reports.” 

Despite resuming 12 weeks later, approximately 10 million test results were not uploaded during the boycott. 

“Companies that have built their business model on channeling and control of a patient’s health data will have to find a new way to drive profit margins for shareholders,” said Mr Butler. 

Mr Butler said he hoped the laws would be passed and in place by mid-next year. 

The federal government’s $1.1 billion digital upgrade promises to revolutionise the “shoebox of PDFs” that is the MHR.  

“By the time Medicare reaches its next milestone birthday, we can confidently expect that the humble fax machine will no longer clutter the offices of health settings,” he said. 

“Like the Sony Walkman or Apple Macintosh, the fax machine will finally become little more than a museum relic.” 

Here is the link:

https://www.medicalrepublic.com.au/no-rebate-for-you-butler-threatens-path-labs-if-they-dont-upload-results/111763

It is going to be interesting to see how this all works out – as it will also be interesting to see if any obvious benefits flow from all this, and of course that no harm is caused with patients spooked by results they don’t understand.

The theory is great – I hope it works out as hoped when implemented. There has to be a good chance this will be the case…..I am still waiting to have any of my results mailed to me for my files, despite repeated requests!!!!

David.

AusHealthIT Poll Number 769 – Results – 20 October 2024.

Here are the results of the poll.

Are You Seeing The Influence Of Climate Change In The Recent Hurricane Season In Florida?

Yes                                                                                  16 (84%)

No                                                                                     3 (16%)

I Have No Idea                                                                 0 (0%)

Total No. Of Votes: 19

A very clear vote, with the feeling being that we are seeing the influence of climate change.

Any insights on the poll are welcome, as a comment, as usual!

Hopeless voting turnout. 

0 of 19 who answered the poll admitted to not being sure about the answer to the question!

Again, many, many special thanks to all those who voted! 

David.

I Guess This Is A Warning We Need To Take Seriously – Given Where It Comes From!

This appeared last week – Nobel Prize week

Physics Nobel winner Brian Hinton issues AI alert

Tom Whipple

9 September,2024

Sometimes on the morning when scientists receive the Nobel prize, they thank their colleagues. Occasionally they talk about the surprise of receiving a call from a Swedish number. Often they are simply overwhelmed. Geoffrey Hinton had other concerns.

Less than an hour after receiving the prize in physics, the British-Canadian AI pioneer warned that the technology he helped create could lead to the subjugation of humanity.

Professor Hinton, who was born in London and now works at the University of Toronto, shared the prize with John Hopfield, from Princeton. Together, 40 years ago, they applied techniques from physics to show how mach­ines could in a sense learn for themselves.

In doing so, they provided tools that helped in the development of AI systems. They also created technology that, Professor Hinton said, could be used for tremendous good but had ­significant dangers.

Machine learning works differently from conventional programming. Rather than relying on programs in which computers are given explicit instructions, it enables them to learn from examples in an analogous manner to humans.

Professor Hinton was honoured for his work on reapplying the equations of Ludwig Boltzmann, a 19th-century physicist. Boltzmann had been looking at a way to understand systems that involved lots of individual elements, such as molecules of gas.

Professor Hinton’s insight was to apply the principles to spotting patterns in data. He separately worked on the “back propagation” algorithms that power today’s AI systems.

Although the work was done in the early 1980s, it came to fruition only in the past 15 years, when the growth in data gave computers enough examples to work from and the growth in computing power gave them the capability. It is key to systems such as ChatGPT.

Yet the power of the technology also led Professor Hinton, 76, to quit his work with Google to warn humanity of its dangers.

Speaking to the Nobel committee, he said humanity was only just starting to understand its power.

“I think it will have a huge influence. It will be comparable with the Industrial Revolution, but instead of exceeding people in physical strength, it will exceed people in intellectual ability. We have no experience of what it is like to have things smarter than us,” he said.

“It’s going to be wonderful in many respects. In healthcare, it has given us much better healthcare. In almost all industries it is going to make them more ­efficient.

“People are going to be able to do the same amount of work with an AI assistant in much less time. It’ll mean huge improvements in productivity.”

He added: “We also have to worry about a number of possible bad consequences, particularly the threat of these things getting out of control.”

Asked whether he had regrets, he said: “In the same circumstance I would do the same again, but I do worry the overall consequence of this might be systems more intelligent than us that eventually take control.”

Computer scientist Neil Lawrence of Cambridge University, where Professor Hinton studied, said: “For me, Hinton’s been a total inspiration. (He) is great because of his ability to inspire multiple fields to come together.”

He said, however, that he did not believe AI was a threat in the way Professor Hinton believed.

“I share some of Geoff’s concerns about the societal aspects of these technologies but disagree on the origin of the problems and the form of the solutions,” he said.

The Times

Here is the link:

https://www.theaustralian.com.au/world/the-times/physics-nobel-winner-brian-hinton-issues-aialert/news-story/e883f04be4db8c6e3418609f0e9b20a5

Well, who am I to quibble? We need to stay alert and make sure, as best we can, that innovations are used overall for good!

David.

I Fear This Is A Sad But Inevitable Truth For Many Of Us. I Find It Frightening.

This appeared last week:

Dementia

Dementia set to become Australia’s leading cause of death

Australian Bureau of Statistics says the 250 deaths between heart disease and dementia in 2023 brings the totals ‘the closest they have ever been’

Sharlotte Thou

Thu 10 Oct 2024 17.56 AEDT

Dementia is on the brink of overtaking heart disease as the leading cause of death in Australia, according to the Australian Bureau of Statistics, which says the 250 deaths between the two conditions are “the closest they have ever been”.

In 2023, which recorded 183,131 deaths nationally, the five leading causes of death were heart disease, dementia (including Alzheimer’s), cerebrovascular disease, lung cancer and chronic lower respiratory disease, ABS data revealed.

Covid fell to the ninth leading cause of death, from third in 2022.

If mortality trends continue to follow expected trajectories, dementia will be the leading cause of death in Australia “in coming years”, the report said.

Over the past 50 years the mortality rate for ischaemic heart disease (also known as coronary heart disease) decreased by 87.9% while dementia increased by 842.8%.

The ABS noted that in its peak in 1968, heart disease accounted for almost a third of deaths, while dementia accounted for just 0.2%.

Lauren Moran, the ABS head of mortality statistics, attributed the change to improvements in medical treatment and an ageing population.

However, the ABS emphasised dementia is not an inevitable part of the ageing process and can occur at all ages.

Overall, the death rate of 5.13 deaths per 1,000 people in 2023 dropped from 5.48 in 2022.

Deaths from Covid almost halved and rates of death fell for most other leading causes, the bureau said.

Two-thirds of people who died from dementia in 2023 were female. It remains the leading cause of death among women, which the bureau said was due to their greater life expectancy.

The Dementia Australia CEO, Prof Tanya Buchanan, said dementia represents 12.2% of all female deaths and 6.4% of male deaths and the numbers are projected to worsen.

There are now an estimated 421,000 Australians living with dementia, she said.

“Without a significant intervention, this number is expected to increase to more than 812,500 by 2054.

“It is crucial that we act now to focus on the brain health of the nation as well as provide more targeted, effective support to those impacted by dementia.”

Suicide remained the leading cause of premature death in 2023, at a rate of 12.1 per 100,000 people.

Three in four people who died from suicide were male, though men who lived in remote Australia were twice as likely to die from suicide as men in capital cities. The 2023 data for males, though still premature, was higher than 2020 rates.

The median age of people who died by suicide was 45 (compared with 82 for all deaths) though this decreased to 33 among Indigenous Australians.

Indigenous people (30.2 per 100,000) were almost three times as likely to die by suicide as non-Indigenous people (11.3 per 100,000), which Prof Pat Dudgeon, a professor of Indigenous health at University of Western Australia, described as “unacceptable”.

Dudgeon said the data, which likely under represents true numbers, “reinforces the harsh reality that in Aboriginal and Torres Strait Islander communities losing loved ones to suicide is not the exception, but tragically common”.

The ABS also found Indigenous people were four times more likely to die unintentionally from drug use and five times more likely to die from diabetes.

In 2023, the median age at death was 82 years. Death rates among those aged 45 were the lowest in the last 10 years, with the death rate for females under 25 decreasing by just over 10% since 2022.

Australia’s National Dementia Helpline is 1800 100 500. The crisis support service Lifeline is 13 11 14. Other international helplines can be found at befrienders.org

 Here is the link:

https://www.theguardian.com/society/2024/oct/10/dementia-set-to-become-australias-leading-cause-of-death

The only point of mentioning this is to say that doing all you can for your brain matters (control blood pressure, stay as fit as you can, avoid head trauma and use your brain when you can etc.) so that at least you brain sees the same distance as your body time wise!

There is little else we can all do but it has to be worth trying  to keep it going well!

I hope you agree…

David.

This Is Certainly Not An Unexpected Finding On The Utility Of Point-Of-Care Ultrasound.

This appeared last week:

Point-of-care ultrasound streamlines care, curbs costs – and saves lives

POCUS has proven itself a cost-effective diagnostic tool that enhances the physical exam, says one Jefferson Healthcare physician. Money is not wasted on excessive testing and patients avoid the hospital because their disease is recognized quickly.

By Bill Siwicki

October 10, 2024 01:06 PM

One of the biggest daily challenges faced by healthcare providers is obtaining accurate diagnostic answers in a timely manner. Clinicians spend years training in physical diagnosis, mastering techniques such as listening to hearts and lungs with a stethoscope, palpating the abdomen, and examining painful joints.

THE PROBLEM

But even in the most expert hands, these traditional diagnostic methods lack the precision needed, said Dr. Stephen Erickson, a board-certified family medicine physician providing care at Jefferson Healthcare's Townsend Clinic.

"To compensate for this, we rely heavily on costly lab tests, time-consuming imaging studies and further interventions to confirm diagnoses," he explained. "In fact, the cost of diagnostic testing in the U.S. healthcare system is staggering. Annual spending on imaging procedures, including expensive X-rays, CTs and MRIs, has been rapidly rising. We're now spending more than $100 billion on these procedures annually.

"Beyond the financial burden, these tests often come with long wait times, contributing to delays in patient care, unnecessary hospitalizations and increased anxiety for patients," he continued. "This inefficiency strains healthcare resources and impacts clinical workflows, making timely and accurate decision making even harder to achieve."

Point-of-care ultrasound, or POCUS, is helping clinicians overcome many of these challenges, he contended. With the ability to visualize the body at the point of care using a pocket-sized ultrasound, clinicians can streamline the diagnostic process, improve accuracy, and save time and money, he said.

"In fact, POCUS has been shown to outperform traditional diagnostic methods in several cases," Erickson noted. "For much of my career, for instance, a suspicion of pneumonia automatically led to ordering a chest X-ray. Today, we know from multiple research studies that lung ultrasound not only provides quicker and less expensive results but is also more sensitive in detecting pneumonia.

"POCUS is transforming the diagnostic landscape, empowering clinicians to make faster, more informed decisions, and ultimately improving patient outcomes," he added.

PROPOSAL

POCUS technology proposes to resolve the problem of diagnostic delays and inaccuracies across many clinical settings, centered on bringing real-time imaging capabilities directly to the bedside.

"Traditionally, medical imaging was confined to specialized radiology departments, with doctors often relying on bulky, expensive equipment like ultrasound cards, CT scans, MRIs or X-rays to get a comprehensive view of a patient's internal structures," Erickson said. "This process, while still highly valuable in some cases, can introduce significant delays, especially in time-sensitive emergency scenarios or in rural settings where access to radiology is often limited.

"POCUS technology changes this by decentralizing imaging and making it accessible to clinicians outside of the radiology department," he continued. "The handheld nature of POCUS devices enables clinicians to perform targeted, immediate scans at the patient's side, without having to wait for specialized equipment or personnel."

POCUS has the ability to provide immediate answers to critical, yes or no, diagnostic questions. For example, in situations where the primary concern is whether a patient is experiencing internal bleeding, a detailed MRI or CT scan may not be immediately necessary. POCUS offers a faster way to detect or rule out such conditions right then and there, he added.

"Plus, new devices on the market in the last half decade have even made it possible to image the whole body with a single, all-in-one probe," Erickson noted. "By placing this technology in the hands of emergency room doctors, nurse practitioners and physician assistants, POCUS offered a streamlined solution to reduce dependency on costly and time-consuming imaging studies.

"It allowed medical professionals to identify urgent issues – such as pleural effusions, pneumothorax or cardiac tamponade – quickly and confidently, guiding immediate treatment decisions," he continued. "This real-time diagnostic tool, then, was supposed to alleviate the problem by providing a faster and more direct method of assessment, particularly in environments where delays in diagnosis could result in poor patient outcomes or when quick decisions were needed for effective triage."

POCUS technology has enabled healthcare providers to bypass traditional bottlenecks in diagnostic processes while still delivering accurate and life-saving information, he added.

"By doing so, it promised to enhance workflow efficiency, reduce wait times and potentially lower healthcare costs, all while improving patient care quality," he said.

MEETING THE CHALLENGE

At Jefferson Healthcare, the integration of POCUS technology began with its deployment in the emergency department, where physicians urgently needed rapid diagnostic capabilities at any time of day.

"Initially, ER doctors used POCUS to quickly assess critical conditions such as internal bleeding, lung problems and cardiac function, which helped streamline decision making and guide immediate treatments," Erickson explained. "The benefits of POCUS in providing fast, reliable diagnostics without the delays of traditional imaging soon became apparent, leading other departments to request access to their own devices.

"Over time, the body of evidence regarding the usefulness of POCUS has grown," he continued. "With this, more and more specialties have asked to have their own POCUS device in their department. To name a few common use cases – in the anesthesia department, POCUS is used to improve the precision of nerve blocks and to assess patients preoperatively for conditions like gastric aspiration risk."

Obstetricians can use POCUS to monitor fetal well-being and positioning, enhancing both routine assessments and responses to emergent situations. Similarly, in orthopedic, rheumatology and sports medicine, POCUS can be a tool to guide more accurate joint injections and to diagnose tendon or ligament injuries with greater precision.

In primary care, physicians use POCUS not only for diagnostics but also as a patient education tool, showing real-time imaging to help patients understand their diagnoses.

"While POCUS started as a standalone tool, it eventually became integrated with electronic health records and imaging databases, enabling clinicians to seamlessly document and share findings with other providers," Erickson said. "In our institution, we have Butterfly iQ handheld POCUS devices deployed in each primary care clinic, our infusion center and our pre-anesthesia ward.

"We also have cart-based ultrasound machines from multiple manufacturers in various locations in our hospital," he continued. "All POCUS machines are networked with DICOM links to our Epic EHR and PACS servers to allow for more optimal workflow and image accessibility across the continuum of care. We also use Butterfly Compass workflow software for QA review of images coming from any POCUS device across the organization."

RESULTS

The POCUS technology has proven itself to be a cost-effective diagnostic tool that significantly enhances the physical examination, Erickson reported.

"One of the challenges of trying to quantify the success of leveraging POCUS is that it is very difficult to measure the money that was not wasted on excessive testing, or the patients who did not end up in the hospital because their disease was recognized more quickly," he noted. "That said, I think any clinician using POCUS can tell you of cases where this occurred."

Erickson offered a few examples of such cases that took place in the past few months.

"A patient who came to my office late in the afternoon with symptoms to suggest a blood clot in a leg vein," he explained. "This is potentially dangerous because an untreated blood clot can break off, go to the heart, and cause a deadly embolism.

"Traditionally this patient would be sent to the emergency room because I can't get a venous ultrasound exam scheduled quickly enough as an outpatient," he continued. "By doing a POCUS exam at a cost of less than $50, I was able to get my answer, start the right treatment and avoid a $2,000 emergency department bill."

Another example: Placement of intrauterine contraceptive devices can be unpredictably painful for some women.

"A quick POCUS scan before placing an IUD can screen for anatomic variations that are likely to result in pain or even dangerous complications such as uterine perforation," Erickson said. "And after IUD placement, women are traditionally asked to come back in six weeks for a second pelvic exam to confirm that the IUD remains in its proper location.

"It has brought great patient satisfaction to instead perform a quick ultrasound to more accurately confirm IUD position without the patient needing to get undressed," he added.

And a final example: An elderly patient who was unable to talk due to a previous stroke was brought in by his spouse because he "just hadn't been acting right."

"My physical exam yielded little useful information as to why," Erickson explained. "It was hard to know if he needed extensive testing, or reassurance. POCUS, however, quickly demonstrated new, severe systolic heart failure. He was sent right to the emergency department where further tests confirmed a large, silent heart attack.

"I shudder to think about the outcome of that case if I hadn't had my POCUS device," he said.

ADVICE FOR OTHERS

"My advice for healthcare organizations that may be thinking about bringing in POCUS technology is to start setting up the IT system interfaces early to be ready for expanded POCUS use in the future," Erickson advised. "Many departments may eventually want POCUS, and each may have their own ideas of what is best for them.

"But an IT or biomedical department doesn't want to be saddled with trying to manage multiple systems that can't work together," he continued. "Get stakeholders to agree on two or three preferred vendors of ultrasound equipment and take the time to set up the DICOM links to your EHR and PACS. Set up standardized training in these workflows for each new user to make sure proper documentation standards are being followed."

These things take time, but they get progressively harder to institute across multiple departments the longer that non-standardized practices have proliferated, he concluded.

Here is the link:

https://www.healthcareitnews.com/news/point-care-ultrasound-streamlines-care-curbs-costs-and-saves-lives

I have to say this is by no means an unexpected finding. In the hands of sensible physicians use of ultrasound can provide very rapid clinical information and diagnostic answers – often at the patient bedside.

So what is not to like? The most important aspect is that ultrasound use – especially at the bedside – makes extra demands on anatomical and pathological knowledge that may have lost its earlier importance and needs re-awakening when expert radiological opinion is not readily accessible!

This is a good thing but a change we need to be aware of!

David.